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成年患者的主动脉瓣下隔膜:临床特征、结局及超声心动图相关性的回顾性研究并文献复习

Subaortic membrane in adult patients: retrospective study of clinical characteristics, outcomes, and echocardiographic associations and review of literature.

作者信息

Itare Vikram, Javed Nismat, Rivas Rosanna Pineda, Mandalapu Navya, Mehta Adrija, Ali Nisha, Ashraf Shoaib, Molina Marcos, Nicu Marin

机构信息

Internal Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY, 10457, USA.

Cardiology, Mount Sinai Morningside-BronxCare, 1111 Amsterdam Avenue, New York, NY, 10025, USA.

出版信息

Int J Cardiovasc Imaging. 2025 Aug 7. doi: 10.1007/s10554-025-03489-5.


DOI:10.1007/s10554-025-03489-5
PMID:40773030
Abstract

This study aims to describe the clinical characteristics, outcomes, and echocardiographic associations of subaortic membranes in adult patients, providing insight into their multifactorial etiology and implications for management. The retrospective study involved identifying patients who underwent Transthoracic Echocardiography (TTE) in the past 10 years from June 2013 to June 2023 due to clinical suspicion of a subaortic membrane and received a confirmed diagnosis of subaortic membrane, either through TTE alone or a subsequent Transesophageal Echocardiogram (TEE). The demographics of the patients, including age at diagnosis, sex, and medical comorbidities such as aortic or mitral valve disease, hypertension, history of arrhythmias, coronary artery disease, heart failure, diabetes mellitus, and chronic kidney disease, were included. Features on TTE were documented. Any subsequent surgical interventions were recorded, specifically subaortic membrane resection and valve repair. A total of 22 cases were studied. The mean age of the cohort was 58.1 ± 10.6 years. Common comorbidities included hypertension (63.6%), obesity (45.4%), and heart failure (31.8%). Quantitatively, the left ventricular (LV) ejection fraction varied from normal (59-76.4%) to moderately decreased (43.8%), with a mean ejection fraction of 65.9 ± 8.0%. Diastolic dysfunction was present in various grades. Six patients had one ICU hospitalization (27.3%), and one patient had more than one ICU hospitalization (4.5%). Most had a subaortic membrane (90.9%) visualized on TTE. Two patients had possible findings suggestive of a subaortic membrane, which was confirmed on TEE (2/22; 9.1%). While most patients had a relatively benign course, three patients (13.6%) had undergone surgical interventions. The majority of the patients survived (17/22; 77.3%). Subaortic membrane is a rare condition with limited incidence, prevalence, and management data. Further large-scale studies are necessary to investigate and compile data to establish guidelines for treatment.

摘要

本研究旨在描述成年患者主动脉瓣下隔膜的临床特征、转归及超声心动图相关性,深入了解其多因素病因及对治疗的影响。这项回顾性研究涉及确定在2013年6月至2023年6月的过去10年中因临床怀疑主动脉瓣下隔膜而接受经胸超声心动图(TTE)检查并经TTE或随后的经食管超声心动图(TEE)确诊为主动脉瓣下隔膜的患者。纳入了患者的人口统计学资料,包括诊断时的年龄、性别以及医学合并症,如主动脉或二尖瓣疾病、高血压、心律失常病史、冠状动脉疾病、心力衰竭、糖尿病和慢性肾脏病。记录了TTE的特征。记录了任何后续的手术干预措施,特别是主动脉瓣下隔膜切除术和瓣膜修复术。共研究了22例病例。该队列的平均年龄为58.1±10.6岁。常见合并症包括高血压(63.6%)、肥胖(45.4%)和心力衰竭(31.8%)。定量分析显示,左心室(LV)射血分数从正常(59 - 76.4%)到中度降低(43.8%)不等,平均射血分数为65.9±8.0%。存在不同程度的舒张功能障碍。6例患者有1次入住重症监护病房(ICU)(27.3%),1例患者有多次入住ICU(4.5%)。大多数患者在TTE上可见主动脉瓣下隔膜(90.9%)。2例患者有提示主动脉瓣下隔膜的可能发现,经TEE确诊(2/22;9.1%)。虽然大多数患者病程相对良性,但3例患者(13.6%)接受了手术干预。大多数患者存活(17/22;77.3%)。主动脉瓣下隔膜是一种罕见疾病,发病率、患病率和治疗数据有限。需要进一步开展大规模研究来调查和汇总数据,以制定治疗指南。

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本文引用的文献

[1]
Contemporary Clinical Characteristics, Imaging, Management, and Surgical and Nonsurgical Outcomes of Adult Patients With Subaortic Stenosis.

J Am Heart Assoc. 2024-11-19

[2]
2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.

Circulation. 2024-6-4

[3]
Now You See Me Now You Don't: Subaortic Membrane Causing a Diagnostic Dilemma.

JACC Case Rep. 2023-6-12

[4]
Insurance-Based Disparities in Congenital Cardiac Operations in the Era of the Affordable Care Act.

Pediatr Cardiol. 2023-4

[5]
Multivalvular destruction as the primary presentation of aggressive infective endocarditis with subaortic valve membrane.

Pak J Med Sci. 2021

[6]
An unusual combination of discreet subaortic membrane, aortopulmonary window, severe aortic insufficiency and rheumatic mitral regurgitation.

Indian J Thorac Cardiovasc Surg. 2018-7

[7]
Subaortic Membranes in Patients With Hereditary Hemorrhagic Telangiectasia and Liver Vascular Malformations.

J Am Heart Assoc. 2020-10-20

[8]
Lethal recurrent mycotic ascending aortic pseudoaneurysm in a 21-month-old child with repaired subaortic membrane.

Ann Pediatr Cardiol. 2020

[9]
It's Not Always Occam's Razor - The Case of a Young Man with Subaortic Membrane with Superimposed Pulmonary Thromboembolism and Left Main Coronary Artery Disease.

Cureus. 2019-10-6

[10]
Left Ventricle to Right Atrial Shunt Associated With Ventricular-Atrial Malalignment, Double Outlet Right Atrium, and Subaortic Membrane.

Semin Thorac Cardiovasc Surg. 2019-9-11

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