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Subaortic stenosis missed by invasive hemodynamic assessment
Fadi G Hage1, Gilbert J Zoghbi, Raed A Aqel
1University of Alabama and Birmingham, Veterans Affairs Medical Center, Division of Cardiology, Birmingham, Alabama, USA. fadihage@uab.edu
Echocardiography (Mount Kisco, N.Y.)
|September 6, 2008
Summary
A discrete subaortic stenosis was missed by invasive hemodynamic assessment in a 61-year-old man. Echocardiography revealed the condition, highlighting potential diagnostic limitations.
Area of Science:
- Cardiology
- Medical Diagnostics
- Cardiac Surgery
Background:
- Aortic stenosis is a common valvular heart disease, often assessed invasively.
- Hemodynamic assessment is crucial for diagnosing and grading outflow tract obstructions.
- Subaortic stenosis can present with varying severity and morphology.
Observation:
- A 61-year-old male presented for evaluation of suspected aortic stenosis.
- Invasive catheterization did not reveal a significant left ventricular outflow gradient.
- Transthoracic echocardiography identified a discrete membranous subaortic stenosis.
Findings:
- Discrete subaortic stenosis can be missed by invasive hemodynamic assessment.
- Echocardiography is vital for detecting subtle left ventricular outflow tract abnormalities.
- This case represents the first reported instance of subaortic stenosis missed by invasive methods.
Implications:
- Echocardiography should be considered even when invasive hemodynamics appear normal for outflow tract obstruction.
- Diagnostic algorithms for suspected aortic stenosis may need refinement.
- Accurate diagnosis of subaortic stenosis is critical for appropriate management and preventing complications.
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