Contemporary Review of Subaortic Stenosis Characteristics, Multi-modality Imaging and Management

This review aims to provide a comprehensive contemporary overview regarding the clinical perspectives, multi-modality imaging evaluation, treatments and outcomes of subaortic stenosis (SAS).

SAS remains an important condition making up a significant minority of patients with progressive fixed left ventricular ouflow tract obstruction. Echocardiography remains the first-line imaging modality to diagnose SAS, evaluate severity of obstruction along with cardiac chamber and valvular function. Transesophageal echocardiography, cardiac computed tomography and cardiac magnetic resonance have adjunctive roles to help delineate SAS anatomy, functional implications and pre-operative planning. A variety of surgical techniques have been developed for SAS with significant obstruction often with symptoms, with excellent contemporary outcomes, though recurrence rates remain significant particularly in younger patients and those with complex anatomical features that may need repeat surgeries. Multi-disciplinary approach to management is necessary to improve clinical outcomes, including multi-modality imaging for diagnosis, risk stratification, treatment guidance and close surveillance, along with meticulous surgery by experienced surgeons, are necessary to improve clinical outcomes for SAS.