• Subaortic membrane
    • Circumferential fibrous ridge with attachments extending from the ventricular septum to the anterior mitral valve leaflet in very close proximity to aortic valve
    • Concentric left ventricular hypertrophy 
      • Secondary to pressure loaded left ventricle in setting of significant subaortic stenosis
  • Subaortic membrane
    • Discrete fibromuscular ridge protruding from the interventricular septum causing subaortic stenosis
  • Subaortic membrane
    • Subaortic membrane (denoted by arrow) noted beneath the aortic valve causing subaortic narrowing 
  • Subaortic membrane
    • Color aliasing begins at the level of the circumferential fibromuscular ridge
    • Mild central aortic regurgitation
  • Subaortic membrane
    • Color aliasing begins at the level of the circumferential fibromuscular ridge located just below aortic valve
    • Mild central aortic regurgitation
    • Concentric left ventricular hypertrophy
  • Subaortic membrane
    • Subaortic membrane (denoted by arrow) noted beneath the aortic valve causing subaortic narrowing 
    • Flow turbulence noted by color Doppler in subaortic region
    • Mild aortic regurgitation

The parasternal long axis view is useful for characterizing the mechanism of subaortic stenosis. The fibromuscular ridge is often discrete, but can be circumferential with attachments to the mitral valve. In some cases, the subaortic stenosis can be tunnel-like with a large portion of the left ventricular outflow tract appearing narrowed and tubular. The distance from the fibrous ridge to the aortic valve should be measured and an interrogation for attachments between the ridge and the aortic valve should take place as these are important factors to assess prior to surgical repair. Color aliasing by Dopper interrogaton will reveal the level where obstruction begins and will detect aortic valve reguritaiton, which is commonly associated with a subaortic membane. This view will also be useful to assess for the presence of a ventricuar septal defect and abnormalities of the mitral valve.      

 

  • Transducer placed on the left sternal border
  • 3rd or 4th intercostal space
  • Notch pointed towards the patient's right shoulder (11 o'clock)
  • Subaortic membrane
    • Defines location of membrane
    • Defines distance to aortic valve
    • Additional attachments to mitral annulus
  • Subaortic stenosis
  • Aortic regurgitation
  • Dysplastic mitral valve
  • Mitral regurgitation