Mitral valvar anomalies causing subaortic stenosis: two rare case reports

Figures

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  Figure 1. Transthoracic echocardiogram findings: parasternal long axis view showing the anomalous insertion of papillary muscle into the ventricular septum (red arrow) and into the aortic leaflet of the mitral valve (yellow arrow), causing a long tunnel-like obstruction associated with left ventricular hypertrophy.

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  Figure 2. Transoesophageal echocardiogram findings: 120° long axis view showing the anomalous insertion of papillary muscle into the ventricular septum (red arrow) and into the aortic leaflet of the mitral valve with an aliasing in the outflow tract in favor of left ventricular outflow tract.

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  Figure 3. Transthoracic echocardiogram findings. (A) Parasternal long axis view showing left ventricular hypertrophy with a subaortic muscular tunnel with ‘muscularization’ of the aortic leaflet of the mitral valve whose juxta-aortic portion is stiff and immobile (red arrow). (B) Aliasing in the outflow tract in favor of left ventricular outflow tract. (C) Apical four chambers view showing circumferential subaortic diaphragm (yellow arrow). (D) Continuous wave Doppler showing an accelerated subaortic flow with a peak gradient of 42 mm Hg.