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Case Reports
. 2025 Aug 8;17(8):e89625.
doi: 10.7759/cureus.89625. eCollection 2025 Aug.

Subaortic Membrane With a Patent Ductus Arteriosus in an Adult Patient: A Challenging Diagnostic Dilemma

Ahmed Youssouf Addou  1 , Jad Ait Lahmouch  1 , Mohammed Aoudad  2 , Amale Tazi  1 , Aatif Benyass  3
Affiliations
Case Reports

Subaortic Membrane With a Patent Ductus Arteriosus in an Adult Patient: A Challenging Diagnostic Dilemma

Ahmed Youssouf Addou et al. Cureus. .

Abstract

Subaortic membrane (SAM) is a subtype of left ventricular outflow obstruction, rarely seen in adults. In some cases, SAM may be associated with other congenital defects. The association of patent ductus arteriosus (PDA) and SAM is the rarest, especially in adult patients. The management of these patients is delicate in terms of diagnosis, timing, and the appropriate surgical technique. A 34-year-old patient with a known aortic heart murmur presented with exertional syncope. She was referred to our hospital for aortic valve replacement due to symptomatic aortic stenosis. Transthoracic and transesophageal echocardiography demonstrated a SAM with significant stenosis (mean gradient 48 mmHg) associated with a PDA, mild to moderate aortic regurgitation (AR), and an ascending aortic aneurysm. The heart team decided to proceed with membrane resection, aortic valve replacement, and ascending aortic graft. This case highlights the challenge of managing adult congenital heart disease, particularly regarding diagnosis and optimal timing for surgical intervention. The subaortic membrane is a structural anomaly that can be either congenital or acquired. The primary indication for surgery is the symptomatic form or its association with severe AR. We believe that prophylactic surgery should be considered in isolated cases of mixed anomalies.

Keywords: aortic aneurysm; aortic regurgitation; left ventricular outflow tract obstruction (lvoto); patent ductus arteriosus; subaortic membrane.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PSAX focus on pulmonary artery showing a PDA with left-to-right shunt
PSAX: parasternal short-axis; PDA: patent ductus arteriosus.
Figure 2
Figure 2. (A) Midesophageal long-axis view showing a discrete subaortic membrane in the LVOT, located 5 mm below the aortic valve. (B) Midesophageal long-axis view with color Doppler demonstrating obstruction in the LVOT.
LVOT: left ventricular outflow tract.
See this image and copyright information in PMC

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