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Isolated sub-aortic obstruction – A cause of left ventricular outflow tract obstruction
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Received: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A seven year old girl† presented in July 2018 to the department of Cardiology, CC Shroff Memorial Hospital, Hyderabad, India, with complaints of exertional palpitations along with increased precordial pulsations. Auscultation revealed a faint ejection systolic murmur, grade II with normal heart sound and no adventitious sounds.
Electrocardiography did not reveal any chamber hypertrophy (Fig. 1). Echocardiography demonstrated a spur-like projection (solid arrow, four-chamber view) into the left ventricular outflow tract (LVOT) at its junction with the basal interventricular septum, under the aortic valve (Fig. 2A–D). Color flow mapping across it displayed turbulence in the form of mosaic color pattern, and Doppler interrogation measured peak gradient of 15.8 mmHg. There was no evidence of aortic regurgitation with a normal morphological tri-leaflet aortic valve and no other associated congenital heart defect (Video).
- Electrocardiography showing nonspecific ST-T changes in inferolateral leads.
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(A-D) Two-dimensional echocardiography in four-chamber (solid arrow, Panel A) and parasternal view (solid arrow, Panel B) showing sub-aortic spur-like projection into the left ventricular outflow tract, with turbulence across the left ventricular outflow tract with color flow mapping (mosaic pattern, Panel C). There was a partial membrane-like structure leading to mild obstruction (continuous wave Doppler, Panel D).
She was closely followed up clinically with the advice of echocardiography every six months. There was no progression of symptoms and a mild gradient across the LVOT with no aortic regurgitation over the next two years.
Video available at https://journals.lww.com/ijmr
Conflicts of Interest: None.
