Ni Made Lintya Andani, Putu Ayu Winda Wirastuti Giri, Putu Patriawan

Imaging findings of subaortic membrane stenosis associated with patent ductus arteriosus: a rare case report

Introduction

Imaging findings of subaortic membrane stenosis associated with patent ductus arteriosus: a rare case report. Explore a rare case of subaortic membrane stenosis associated with patent ductus arteriosus (PDA). This report highlights the crucial role of CT angiography in accurate diagnosis and preoperative planning for this complex congenital heart condition.

Abstract

Introduction: Subaortic membrane stenosis is an uncommon congenital abnormality that may accompany other anomalies, such as patent ductus arteriosus (PDA), resulting in diagnostic and therapeutic difficulties. Subaortic stenosis frequently coexists with other congenital abnormalities. The prevalence of concomitant abnormalities is 50–65%, predominantly occurring with patent ductus arteriosus in 34% of instances. The reported prevalence varies from 6.1 per 10,000 live births to 6–6.5% among all individuals with congenital cardiac disease. This case report aims to present a rare instance of subaortic membrane stenosis linked to patent ductus arteriosus, highlighting the need for multimodality imaging, especially CT angiography, in verifying the diagnosis and directing care. Case description: A 19-year-old female complains of easy fatigability for the past 6 months. The result of electrocardiography was sinus rhythm, LVH with multiple PVCs. Chest X-ray showed cardiomegaly with pulmonary congestion accompanied by pulmonary plethora. After echocardiography patient was diagnosed with PDA and subaortic membrane stenosis. From the Cardiac CT and Calcium Scoring, also Pulmonary CT Angiography revealed a hypodense linear structure located on the inferior aspect of the aortic valve, predominantly on the right leaflet, which confirms the diagnosis of Subaortic membrane stenosis with PDA. Conclusion: CT Angiography can provide valuable preoperative information in patients with subaortic membrane stenosis, where detailed knowledge of the surgical site is desired.

Review

This case report effectively highlights a rare co-occurrence of subaortic membrane stenosis and patent ductus arteriosus (PDA), a combination acknowledged by the authors to present significant diagnostic and therapeutic complexities. While subaortic stenosis is known to frequently coexist with other congenital heart defects, often presenting with PDA, this specific report emphasizes the challenges in diagnosing such an unusual pairing. The authors appropriately position their work as addressing a gap by showcasing the vital role of multimodality imaging, particularly CT angiography, in clarifying these intricate anatomical relationships. The clinical presentation of a 19-year-old female with easy fatigability, alongside initial findings of left ventricular hypertrophy and cardiomegaly, sets the stage for a diagnostically challenging scenario. The progression from initial suspicion via echocardiography to definitive confirmation underscores the report's central message. The detailed description of a hypodense linear structure on Cardiac CT and Pulmonary CT Angiography, precisely located inferior to the aortic valve, provides compelling evidence for the subaortic membrane stenosis, solidifying the combined diagnosis with PDA. This methodical diagnostic pathway illustrates the added value of advanced imaging when initial modalities provide an incomplete picture. The conclusion drawn by the authors, emphasizing the invaluable preoperative information provided by CT Angiography, is well-supported by the presented case. This report serves as a strong reinforcement of the critical role of comprehensive imaging in congenital heart disease, particularly for rare or complex presentations requiring surgical intervention. While a single case report, it effectively contributes to the clinical literature by illustrating best practices in diagnostic imaging for such challenging anomalies, ultimately guiding better surgical planning and patient care in similar future cases.

Full Text

Comments

You need to be logged in to post a comment.