Abstract
A 31-year-old woman presented to our hospital with complaints of worsening shortness of breath. She had a history of heart murmur detected during childhood.
During the eighth month of her pregnancy, she experienced presyncope and heart failure. There was a progression of symptoms 6 months after delivery.
A transthoracic echocardiogram showed normal LV function and tiny valves, including a three leaflet-shaped aortic valve, but pressure gradient within the left ventricular outflow tract (LVOT) was greater than 80 mm Hg. There was a tiny membrane in the LVOT, initially overlooked by transthoracic but well seen by transesophageal echocardiography (Fig 1).
The presence of this obstruction was then confirmed on cardiac computed tomography (Fig 2) that demonstrated a fibromuscular shelf located at the area of aortomitral continuity with the extension toward the septum. Revision of the LVOT and aortic valve was performed, and an abnormal membrane in the LVOT was resected (Fig. 3).
There were no perioperative complications.