Ansa V O, Etiuma A U, Odudu-Umoh I, Eboh G
Cardiology Unit, Department of Medicine University of Calabar Teaching Hospital,Calabar,Nigeria.
West Afr J Med. 2011 Sep-Oct;30(5):380-3.
Cases of discrete subaortic stenosis are rare in adults. To our knowledge, no case has been reported in Nigerian literature. Cases are thus likely to be missed or wrongly managed.
To present a case of discrete membranous subaortic stenosis in an adult Nigerian with a view to creating awareness of the existence of this entity in our milieu.
The patient a 46-year-old Nigerian presented with symptoms of angina pectoris and near syncope. Transthoracic 2-Dimensional / M-mode echocardiography demonstrated thickened and calcific aortic valves and laboratory investigations showed that he also had artherogenic dyslipidaemia. He was initially managed as a case of severe valvular aortic stenosis of rheumatic origin with associated dyslipidaemia and was referred for further evaluation and management abroad.
On further assessment at the referral centre, the diagnosis was reviewed to subaortic stenosis with severe left ventricular outflow tract obstruction (LVOTO) arising from a fibro muscular subaortic membrane after a repeat 2-D/M-mode and Doppler echocardiography. Coronary angiography showed normal coronaries. He had excision of the membrane with marked reduction in gradient across the left ventricular outflow tract. He has remained symptom free and stable thereafter.
Discrete membranous subaortic stenosis though rare in adults should be suspected in patients with clinical features of valvular aortic stenosis. Doppler echocardiography is thus mandatory in the evaluation of these patients.
成人孤立性主动脉瓣下狭窄病例罕见。据我们所知，尼日利亚文献中尚未有相关病例报道。因此，此类病例可能会被漏诊或误诊。
报告一例成年尼日利亚人孤立性膜性主动脉瓣下狭窄病例，以提高我们对该疾病在本地存在情况的认识。
该患者为一名46岁的尼日利亚人，出现心绞痛和接近晕厥的症状。经胸二维/M型超声心动图显示主动脉瓣增厚并钙化，实验室检查表明他还患有致动脉粥样硬化性血脂异常。他最初被诊断为风湿性重度瓣膜性主动脉狭窄合并血脂异常，并被转诊至国外进行进一步评估和治疗。
在转诊中心进一步评估时，经重复二维/M型和多普勒超声心动图检查后，诊断被重新审定为主动脉瓣下狭窄，伴有由纤维肌性主动脉瓣下膜引起的严重左心室流出道梗阻（LVOTO）。冠状动脉造影显示冠状动脉正常。他接受了膜切除术，左心室流出道压力阶差明显降低。此后他一直无症状且病情稳定。
尽管成人孤立性膜性主动脉瓣下狭窄罕见，但对于有瓣膜性主动脉狭窄临床特征的患者应怀疑此病。因此，对这些患者进行评估时，多普勒超声心动图检查必不可少。
