COEXISTENT AORTIC VALVULAR AND FUNCTIONAL HYPERTROPHIC SUBAORTIC STENOSIS - CLINICAL, PHYSIOLOGIC AND ANGIOGRAPHIC ASPECTS

Four cases of coexistent aortic valvular stenosis and functional subaortic stenosis are presented. The first patient died of low cardiac output after replacement of the aortic valve, and concomitant subvalvular hypertrophy was discovered at autopsy. Patients presenting clinically with aortic valvular stenosis were subsequently challenged with isoproterenol at cardiac catheterization. Three had hemodynamic evidence of subaortic functional hypertrophy and aortic valvular stenosis. Postextrasystolic beats were also indicative of subaortic stenosis in these cases. All had angiographic evidence of subaortic functional hypertrophy and, in 1, confirmation was obtained at postmortem examination. These studies indicate: (1) patients with both conditions appear clinically to have valvular stenosis; (2) all patients with apparent aortic stenosis should be studied with isoproterenol at catheterization; (3) patients with both lesions should be treated with propranolol; and (4) if this treatment does not result in improvement, then the subvalvular narrowing should be carefully evaluated and relieved at the time of valvular operation. © 1969.