87 years old female admitted with shortness of breath and signs of heart failure. She had a loud ejection systolic murmur on auscultation and therefore a transthoracic echocardiogram was ordered in order to exclude severe aortic stenosis.
Clinical case information
Parasternal long axis with colour: The left ventricle is normal in size with concentric hypertrophy and with good systolic function. Right ventricle is normal in size with good systolic function. Colour Doppler shows turbulence across the left ventricular outflow tract and the aortic valve.
Parasternal short axis view focused on the aortic valve: The valve is tricuspid with slightly thickened leaflets but opening seems to be unrestricted.
Parasternal short axis view at the level of the aortic valve, with colour Doppler: In spite of the wide opening of the valve, colour Doppler shows turbulence across the valve, which may raise the suspicion of another cause of obstruction.
Apical five chamber view with a zoom on the aortic valve: There is an echogenous structure immediately above the aortic valve. This structure is a subaortic membrane.
Subcostal view: the left ventricle is normal in size with concentric hypertrophy. There is good left ventricular systolic function. The right ventricle is normal in size with good systolic function.
Continuous wave Doppler for assessment of aortic regurgitation. Pressure half time is measured by the slope of the continuous wave signal. It is equal to 520 ms suggesting mild aortic regurgitation.
Continuous wave across the subaortic membrane for the assessment of stenosis. (Peak velocity: 5 m/sec, mean pressure gradient: 52 mmHg, peak pressure gradient: 80 mmHg). Data are compatible with severe stenosis.
Dedicated stand alone non-imaging (pencil) probe or Pedoff transducer for the assessment of aortic severity. The velocity recorded is the same as with continuous wave Doppler (peak velocity: 5 m/sec, mean pressure gradient: 52 mmHg, peak pressure gradient: 80 mmHg). The stenosis caused by the subaortic membrane is severe.
Transthoracic echocardiogram demonstrated a subaortic membrane that causes severe obstruction to the left ventricular outflow tract.
The patient was submitted for surgery.