Membranous subaortic stenosis presenting decades after surgical correction for tetralogy of Fallot

Subaortic stenosis is rare in the middle-aged adult. Its association with tetralogy of Fallot is extremely rare. We report two middle-aged patients, presenting three decades after surgical repair of tetralogy of Fallot, with the rare association of subaortic stenosis. The clinical presentation in each patient mimicked residual pulmonary stenosis and insufficiency, but echocardiography revealed subaortic stenosis with associated valvular aortic regurgitation.