Describes the pathophysiology and clinical presentation of low subvalvular aortic stenosis due to asymmetrical hypertrophy, highlighting late systolic stenosis and marked ECG changes.
Case report of hypertrophy-driven late systolic stenosis; hypothesis-generating and should not yet change practice.
Eight cases with low subvalvular aortic stenosis have been described. Two of them had also a narrowing with a pressure gradient in the right ventricle. The stenosis is caused by an asymmetrical hypertrophy and an abnormal course of the muscle bundles of the ventricles with a disturbance in the mode of contraction. The stenosis is more marked during late systole as seen from cardioangiography and pressure recordings. The murmur is therefore late systolic and its maximal intensity is heard over the apex or at left sternal border at the 4th left interspace. The electrocardiogram shows signs of left ventricular hypertrophy which are more marked than expected from the degree of stenosis.
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Bevegård et al. (1962) studied this question.
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