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J Thorac Cardiovasc Surg 2007;134:240-241
© 2007 The American Association for Thoracic Surgery

Brief Communication

Subvalvular aortic stenosis: Comprehensive cardiac evaluation with dual-source computed tomography

Paul Stolzmann, MDa, Hans Scheffel, MDa, Dominique Bettex, MDb, Christoph Karloa, Thomas Frauenfelder, MDa, René Prêtre, MDc, Borut Marincek, MDa, Hatem Alkadhi, MDa,*

a Institute of Diagnostic Radiology, University Hospital, Zurich, Switzerland
b Institute of Anesthesia, Division of Cardiovascular Anesthesia, University Hospital, Zurich, Switzerland
c Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.

Received for publication February 27, 2007; accepted for publication March 8, 2007.

* Address for reprints: Hatem Alkadhi, MD, Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. (Email: hatem.alkadhi@usz.ch).

The first 20% of the full text of this article appears below.

Subvalvular aortic stenosis (SAS) represents a fixed obstruction of the left ventricular outflow tract (LVOT) by an endocardial fold, fibrous tissue, or fibromuscular ridge. Echocardiography including color Doppler is the modality of choice to establish the diagnosis and to assess the extent and hemodynamic severity of SAS.1Go We present imaging findings of a cardiac dual-source computed tomographic (CT) examination in a patient with SAS to demonstrate the potential of the noninvasive modality for a comprehensive evaluation of patients with the disease.

Clinical Summary

A 40-year-old woman was referred for follow-up after resection of a SAS 32 years ago. Clinical examination revealed a systolic grade 3/6 heart murmur and electrocardiography (ECG) showed stress-induced ST-segment depressions. Echocardiography demonstrated recurrence of the SAS causing LVOT obstruction (mean systolic pressure gradient 50 mm Hg). In addition, mild aortic regurgitation and prolapse of the anterior mitral valve leaflet were diagnosed. Thus, the patient was advised to undergo surgical resection of the SAS with aortic valve replacement.

Preoperative workup included a CT coronary angiographic examination for exclusion of coronary artery disease. The patient underwent retrospective ECG-gated dual-source CT (Definition, Siemens Medical Solutions, Erlangen, Germany) after intravenous administration of 65 mL of iodinated . . . [Full Text of this Article]






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