Co-existing Subaortic Stenosis in a Patient with Hypertrophic Obstructive Cardiomyopathy (HOCM): A Rare and Interesting Finding

Hypertrophic Obstructive Cardiomyopathy (HOCM) is an autosomal dominant disorder leading to Left Ventricular Outflow Tract Obstruction (LVOTO). It can present with chest pain, syncope, breathlessness, or in some cases sudden cardiac death. Primarily, it is diagnosed based on echocardiographic findings but cardiac Computed Tomography (CT) or cardiac Magnetic Resonance Imaging (MRI) can be helpful in selected cases. In this case report, we discuss a case of a youngaged female patient previously diagnosed as HOCM and presented with chest pain, shortness of breath, and palpitations. Her echocardiography revealed severe asymmetrically hypertrophied Left Ventricle (LV) with normal function and systolic anterior motion of the mitral valve was present and a subvalvular aortic membrane was also seen. The Computed Tomography (CT) was also performed showing severe asymmetrical hypertrophied and thickened trileaflet tricommissural aortic valve with no calcification or significant valvular aortic stenosis but there was a subaortic membrane (concentric only sparing anteriorly). The presence of subaortic membrane with HOCM is a rare finding and it can be a diagnostic challenge and untreated cases are susceptible to progressive heart failure and worsening of the symptoms by further increasing LVOTO. A thorough investigation and planning before surgical intervention is required to achieve optimal results.

Author(s): Raja Shakeel Mushtaque*, Rabia Mushtaque, Muhammad Idrees Soomro, Shahbano Baloch and Haseeb Bhatti

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