SUBPULMONARY AND SUBAORTIC RIDGES IN DOUBLY COMMITTED SUBARTERIAL VENTRICULAR SEPTAL-DEFECT - AN ECHOCARDIOGRAPHIC STUDY

Background Certain conditions, including discrete subaortic stenosis a nd right ventricular outflow tract obstruction are well-known associat ions with ventricular septal defect. However, the association of discr ete type subpulmonary and subaortic stenosis with ventricular septal d efect has not been described to date. Patients In this report we prese nt our experience in nine patients with doubly committed subarterial v entricular septal defect in whom associated discrete subpulmonary and subaortic stenosis were diagnosed by two-dimensional echocardiography. The mean age of the patients was 5.7 years, and eight of them were ma le. Two patients had additional hypertrophied anomalous muscle bundles with pressure gradients across the right ventricular outflow tract. A ortic valve prolapse was detected in two patients with one of them hav ing mild aortic regurgitation. Intervention Cardiac catheterization wa s performed in four patients, and three underwent surgery. Doubly comm itted subarterial ventricular septal defect was closed, and subpulmona ry and subaortic ridges were resected in each patient. Histological fi ndings were similar for both ridges, which were composed of thin, shor t and irregularly arranged elastic fibres covered by endothelial cells .Results The finding of fibrous ridge on both sides of the doubly comm itted ventricular septal defect, where the turbulence is likely to be maximum, and the histopathological similarities of subpulmonary and su baortic ridges, may suggest a common mechanism for the development of fibrous ridges. Conclusion Serial echocardiographic assessment of pati ents with doubly committed ventricular septal defect is recommended.