Progressive Subvalvular Right Ventricular Outflow Tract Obstruction With a Single Coronary Artery in an Adult

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Subvalvular right ventricular outflow tract obstruction (n=1). Intervention: Multimodality imaging and right heart catheterization. Primary outcome: Subvalvular RVOT pressure gradient.

Q: What does this research mean for the field?

Progressive subvalvular right ventricular outflow tract obstruction in adults can result from combined congenital and post-infective remodeling, producing severe hemodynamic gradients complicated by anomalous coronary anatomy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Masashi Koga; Rei Ito; Syoko Doi; Atsuhiko Sugimoto

doi:10.1016/j.jaccas.2026.107522

March 1, 2026JACC Case ReportsOpen Access

Progressive Subvalvular Right Ventricular Outflow Tract Obstruction With a Single Coronary Artery in an Adult

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Key result

Multimodality imaging identifies severe RVOT obstruction with a ~175 mm Hg gradient and high-risk coronary anatomy.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY

Key Points

To describe the hemodynamic presentation and clinical evaluation of progressive subvalvular right ventricular outflow tract obstruction in an adult with an anomalous single coronary artery.
Evaluated a 57-year-old man presenting with exertional dyspnea, cardiac murmur, and a history of ventricular septal defect and infective endocarditis.
Performed comprehensive multimodality imaging and invasive hemodynamics using electrocardiography, transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance, coronary angiography, and right heart catheterization.
Right heart catheterization revealed a proximal right ventricular systolic pressure of 190 mm Hg and a pulmonary artery systolic pressure of 15 mm Hg, confirming a severe peak-to-peak gradient of 175 mm Hg (progressed from 54 mm Hg measured 8 years earlier).
Transthoracic echocardiography demonstrated severe subvalvular narrowing with a peak velocity of 5.0 m/s across the right ventricular outflow tract.
Coronary angiography and computed tomography confirmed a single coronary artery arising from the left coronary sinus (Lipton type L1) with an anterior branch crossing the outflow tract.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 57-year-old man with a history of ventricular septal defect and prior infective endocarditis presenting with progressive exertional dyspnea.

E

Exposure

Comprehensive multimodality imaging (cardiac CT, CMR, echocardiography, right ventriculography, coronary angiography)

O

Outcome

Diagnosis and hemodynamic assessment of right ventricular outflow tract obstruction and coronary anatomysurrogate

Progressive subvalvular RVOT obstruction in adults warrants evaluation for both congenital and acquired mechanisms, and multimodality imaging is essential to define potentially hazardous coronary anatomy before surgical planning.

Implication

Multimodality imaging is essential before intervention in adult subvalvular RVOT obstruction; leaves open optimal management in single coronary artery anatomy.

Abstract

CASE SUMMARY: A 57-year-old man with a history of ventricular septal defect and prior infective endocarditis presented with progressive exertional dyspnea. Multimodality imaging demonstrated severe subvalvular right ventricular outflow tract (RVOT) obstruction with a marked intraventricular pressure gradient (190 mm Hg proximal right ventricle vs 15 mm Hg pulmonary artery). Coronary angiography revealed a single coronary artery arising from the left coronary sinus (Lipton type L1), with a branch crossing anterior to the RVOT. DISCUSSION: Progression of obstruction suggested evolving double-chambered right ventricular physiology and/or superimposed infection-related remodeling. The anomalous coronary course had important procedural implications. TAKE-HOME MESSAGES: Progressive subvalvular RVOT obstruction in adults warrants consideration of both congenital mechanisms, such as double-chambered right ventricle, and acquired causes including prior infective endocarditis. Comprehensive multimodality imaging is essential to define coronary anatomy and hemodynamic severity before considering intervention.

Discussion

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Cite This Study

Koga et al. (2026) conducted a case report in Subvalvular right ventricular outflow tract obstruction (n=1). Multimodality imaging and right heart catheterization was evaluated on Subvalvular RVOT pressure gradient. Multimodality imaging demonstrated severe subvalvular right ventricular outflow tract obstruction with a 175 mm Hg peak-to-peak gradient alongside a single coronary artery with hazardous anatomy for surgical intervention.

synapsesocial.com/papers/69c2294caeb5a845df0d381e https://doi.org/10.1016/j.jaccas.2026.107522

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Progressive Subvalvular Right Ventricular Outflow Tract Obstruction With a Single Coronary Artery in an Adult

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Progressive Subvalvular Right Ventricular Outflow Tract Obstruction With a Single Coronary Artery in an Adult

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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