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Subaortic Membrane

Case Detail

Anatomy: Vascular-Lymphatic
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

10 year old with trisomy 21 and prior congenital heart defect repair.


Case Images


Diagnosis

Subaortic Membrane

Findings

CT – Optimized coronal image from a CT angiogram demonstrating a circumferential membrane below the aortic valve plane.

Discussion

Left ventricular outflow tract obstructions encompass a series of stenotic lesions starting in the anatomic left ventricular outflow tract and stretching to the descending portion of the aortic arch. Obstruction may be subvalvar, valvar, or supravalvar. These obstructions to forward flow may present alone or in concert, as in the frequent association of a bicuspid aortic valve with coarctation of the aorta. All of these lesions impose increased afterload on the left ventricle and, if severe and untreated, result in hypertrophy and eventual dilatation and failure of the left ventricle. Left ventricular outlet obstructions are congenital in the vast majority of children and associated with various congenital heart defects (most commonly septal defect, patent ductus arteriosus, aortic arch anomalies, bicuspid aortic valve, abnormal left ventricular papillary muscle, Shone complex, and persistent superior left vena cava). In most patients, subaortic membrane is detected in the course of follow-up care for associated congenital heart disease. Many patients are asymptomatic although exertional dyspnea or aortic valve dysfunction may be present. Resection with or without myotomy is the treatment of choice.

Reference

Aboulhosn J, Child JS. Congenital Heart Disease for the Adult Cardiologist – Left Ventricular Outflow Obstruction: Subaortic Stenosis, Bicuspid Aortic Valve, Supravalvar Aortic Stenosis, and Coarctation of the Aorta. Circulation (2006); 114:2412-2422.



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