Discrete Subaortic Stenosis Complicated by Aortic Valvular Regurgitation

WATHEN the physician encounters a patient in whom the clinical examination, the electrocardiogram, and roentgenograms indicate the presence of combined aortic stenosis and regurgitation, he will usually attribute these findings to an aortic valve that has been rendered both stenotic and regurgitant by rheumatic valvulitis and its sequelae. Indeed, in the vast majority of patients, this clinicopathologic correlation will prove to be correct when the valve is examined at operation or autopsy. Recently, however, four interesting exceptions to this general rule were encountered in patients studied at the National Heart Institute. In each of them a congenital subaortic membrane was responsible for obstruction to left ventricular outflow, and the aortic valve had been rendered incompetent by bacterial endocarditis. In three of the patients operation was carried out, and the operative findings, the methods of surgical treatment, and the results of hemodynamic studies are presented. The fourth patient died before operation, and the necropsy finding provide information concerning the etiology of the anatomic malformations observed in this combination of congenital and acquired heart disease.