From the Division of Cardiology, Cardiac Surgery (Y.-J.Y.), National
Cheng Kung University Medical College and Hospital, and Chi-Mei Foundation
Hospital (W.-S.W.), Tainan, Taiwan.
A 52-year-old man complained of dyspnea on exertion
for 1 month. On auscultation, a grade 3/6 to-and-fro murmur was heard
at the left lower sternal border and was well transmitted to the apex.
Fig 1
The patient underwent open-heart surgery several days
later.Surgery revealed a 1x2-cm defect at the right
coronary sinus of Valsalva and a huge subaortic membrane
(10x20 cm) adhering to the right coronary cusp and
interventricular septum (Fig 4
The aortic valve was replaced, and the subaortic membrane was
successfully excised. The postoperative course was smooth, and the
patient was discharged.
Footnotes
Reprint requests to Jyh-Hong Chen, MD, PhD, Department of Internal Medicine, National Cheng Kung University Hospital, 138, Sheng-Li Rd, Tainan, 70428, Taiwan.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Unusual Manifestation of Subaortic Membrane
is the
transesophageal echocardiographic image
of this patient at that time. Figs 2 and 3 were produced by cardiac
catheterization. There was no significant pressure
gradient among aorta, subaortic chamber, and left ventricle.
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Figure 1. Transesophageal
echocardiography demonstrated a calcified aortic
valve and a serpentine, elongated subaortic membrane adhering to right
coronary cusp and interventricular septum. AO
indicates aorta; LA, left atrium; LV, left ventricle; NCC,
noncoronary cusp; RCC, right coronary cusp; arrows,
subaortic membrane; SA, subaortic membrane; SA, subaortic chamber; and
RV, right ventricle.
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Figure 2. Aortogram with right anterior oblique
projection showed an eccentric regurgitant jet (arrow) from aorta
toward left ventricle, and an abnormal subaortic chamber (SA) was also
simultaneously visualized. Two arrowheads outline subaortic
membrane.
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Figure 3. Atypical subaortic membrane with chamber
(SA) was demonstrated in left anterior oblique projection with
cranial beam angulation. Side hole of catheter was placed at subaortic
chamber, and contrast medium was injected. Jet (white arrow) formed by
regurgitation of contrast medium through narrow orifice
in membrane into left ventricle was found. Another jet (black arrow)
was aortic regurgitation. ). There was an orifice in the subaortic
membrane for communicating with the left ventricle.
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Figure 4. At surgery, tricuspid aortic valve was
displaced and subaortic membrane (SM) was exposed. Probe was placed
from defect of right coronary sinus of Valsalva (double arrow)
to another defect in subaortic membrane (single arrow).
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  R. L. Berger and I. Kronzon The vanishing subaortic membrane Eur J Echocardiogr, July 1, 2008; 9(4): 569 - 571. [Abstract] [Full Text] [PDF]
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