Tayel Hesham, Elhakim Abdelrahman, Elsoudi Mohamed, Nour Amira, Saad Mohammed
Cardiology Department, Menofia University, Gamal Abd El-Nasir, Shebeen El-Kom, Menofia 6132501, Egypt.
Cardiology Department, Schleswig-Holstein University Hospital-Kiel, Arnold-Heller-Street 3, 24105 Kiel, Germany.
Eur Heart J Case Rep. 2024 Nov 22;8(12):ytae621. doi: 10.1093/ehjcr/ytae621. eCollection 2024 Dec.
The combination of symptomatic aortic stenosis (AS) and subaortic membrane (SAM) is rare, and the haemodynamic consequences of this combination are challenging to diagnose and manage.
We present the case of a 78-year-old male who presented with symptomatic AS and chronic heart failure. On echocardiography, the combination of AS and SAM was diagnosed. Transoesophageal echocardiography (TOE) was performed to confirm the presence and severity of AS and SAM. Based on the patient's clinical profile and the high risk of surgical repair, a self-expandable transcatheter aortic valve implantation (TAVI) was performed. Three-month follow-up was uneventful. In addition, we discuss the assessment and management strategy challenges for SAM in patients with aortic regurgitation or AS.
As transcatheter valve implantation expands its indications for more complex anatomy and patient's comorbidity. Self-expandable TAVI-prosthesis under TOE guidance is feasible for the treatment of symptomatic AS and SAM, especially in patients with high surgical risk.
有症状的主动脉瓣狭窄（AS）与主动脉瓣下隔膜（SAM）合并存在的情况较为罕见，这种合并情况的血流动力学后果在诊断和管理方面具有挑战性。
我们报告一例78岁男性患者，表现为有症状的AS和慢性心力衰竭。经超声心动图检查，诊断为AS与SAM合并存在。行经食管超声心动图（TOE）检查以确认AS和SAM的存在及严重程度。基于患者的临床情况及手术修复的高风险，实施了自膨胀经导管主动脉瓣植入术（TAVI）。三个月的随访结果良好。此外，我们还讨论了主动脉瓣反流或AS患者中SAM的评估及管理策略挑战。
随着经导管瓣膜植入术的适应证扩展至更复杂的解剖结构和患者合并症。在TOE引导下的自膨胀TAVI假体对于有症状的AS和SAM的治疗是可行的，尤其是对于手术风险高的患者。
