Membranous subaortic stenosis presenting decades after surgical correction for tetralogy of Fallot

Subaortic membrane late after surgical correction of tetralogy of Fallot

We herein report a rare case of subaortic stenosis in association with a previous tetralogy of Fallot (TOF) surgical repair, which was not taken into account as a differential diagnosis. Echocardiography plays a pivotal role in identification of this rare combination. Therefore, echocardiography should be performed periodically during follow-up of patients with surgically corrected TOF. Given the clinical complications that can result from subaortic stenosis (i.e., aortic regurgitation and infective endocarditis), early and aggressive management of this rare combination should be performed.

Pulmonary atresia with intact ventricular septum coexisting with coarctation of the aorta

A newborn with pulmonary atresia, intact ventricular septum, and a bicommissural aortic valve underwent percutaneous pulmonary valvotomy at 1 day of age. Severe coarctation of the aorta became apparent only after spontaneous closure of the ductus arteriosus at 5 weeks of age, requiring repair by surgical end-to-end anastomosis. This is the first report of a child with pulmonary atresia with intact ventricular septum in association with coarctation of the aorta.

Early onset of progressive subaortic stenosis after complete repair of tetralogy of Fallot

Tetralogy of Fallot is often found in association with a wide variety of other cardiac lesions, but is rarely found in association with lesions causing obstruction to the left ventricular inflow or outflow. Subaortic stenosis has only rarely been reported in association with tetralogy of Fallot. We report a patient with Marfan syndrome who underwent repair of tetralogy of Fallot at five years of age. Discrete and progressive subaortic stenosis developed two years after the surgical correction, in a previously normal and unobstructed left ventricular outflow tract. Surgical removal of the acquired fibrous subaortic shelf was successful. Clinical signs of obstruction within the left ventricular outflow tract after surgical repair of tetralogy of Fallot should prompt further investigation to exclude the onset of acquired subaortic stenosis.