Early aortic valve closure in combined idiopathic hypertrophic subaortic stenosis and discrete subaortic stenosis

A patient with idiopathic hypertrophic subaortic stenosis (90 mm Hg resting intraventricular gradient) and discrete subaortic stenosis was found to have two separate systolic closing movements of the aortic valve on M mode echocardiography, each movement being associated with a separate systolic ejection murmur. The first closing movement occurred early in systole and was attributed to alterations in flow across the discrete stenosis. The second closing movement coincided with a later systolic murmur and systolic anterior motion of the mitral valve. The case supports the concept that timing of early closing movements of the aortic valve is useful in the diagnosis of subvalvular obstruction.