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Published on: October 28, 2020
Dual-Level Left Ventricular Outflow Tract Obstruction in an Adult
Elliot Roufeh1, Ziad Hindosh1, Joshua Lee2
1Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA.
Background:
Discrete subaortic membranes are an uncommon cause of left ventricular outflow tract (LVOT) obstruction in adults and may coexist with aortic valve disease.
Case Summary:
A 50-year-old man presented with acute decompensated heart failure. Transthoracic echocardiography showed reduced ejection fraction (30%-35%) and demonstrated severe calcific aortic stenosis with regurgitation. Transesophageal echocardiography revealed a discrete subaortic membrane causing additional subvalvular obstruction, consistent with dual-level LVOT obstruction. Invasive hemodynamics confirmed advanced afterload-mediated heart failure. The patient underwent surgical membrane resection and mechanical valve replacement with subsequent clinical and hemodynamic improvement.
Discussion:
Coexisting subvalvular and valvular obstruction is uncommon in adults and may present diagnostic challenges. Multimodality imaging is essential to differentiate obstruction levels and guide surgical management.
Take-Home Message:
Comprehensive multimodality imaging is essential to identify dual-level LVOT obstruction and ensure correction of both valvular and subvalvular disease.
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