Ventricular Septal Myectomy and Mitral and Aortic Valve Replacement in the Case of Discrete Subaortic Stenosis

We experienced a case of discrete subaortic stenosis of fibromuscular collar type, complicated with asymmetrical thicking of the ventricular septum and abnormal attachment of the tendinous cords of the mitral leaflet accompanied by mitral incompetence and aortic incompetence due to infective endocarditis. Surgical treatment comprised resection of subaortic stenotic fibrous tissues, ventricular septal myectomy and replacement of mitral and aortic valves. Preoperative pressure gradient of 120 mmHg across the left ventricular outflow tract was improved to 22 mmHg with a favorable clinical course. This was considered a rare case where fibromuscular type of DSS was accompanied not with secondary myocardial hypertrophy but with IHSS and abnormal tendinous cords of mitral leaflet.

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