Discrete subaortic membranes in adults--a clinicopathological analysis.
BACKGROUND
A discrete subaortic membrane (DSM) is one of the causes of subaortic stenosis in children. The incidence, characteristics, and the therapeutic options for such membranes in adults have not been well documented. This report documents the clinical and pathological features of DSM in adults.


METHODS
DSMs, surgically excised over a 10-year period in a large adult tertiary care center, were reviewed with regard to the age and gender of the patients, clinical findings, and the morphological features.


RESULTS
Among the 19 adults, there were six males and 13 females, with age ranging from 26 to 75 years. The patients most often presented with dyspnea, fatigability, and palpitation for 3 months to 2 years. Four patients (21%) had other congenital heart disease in association with the DSM; in the rest, the membranes were isolated occurrences (79%). A cardiac murmur or the presence of membranes had been noted in childhood in four patients. Tissue growths over the ventricular surface of the anterior mitral leaflet were seen in 18 cases. Irrespective of the gross appearance, the stenosing lesions exhibited five tissue layers, beginning from the luminal aspect, endothelium, acid mucopolysaccharide-rich subendothelial layer, collagen-rich fibrous layer, fibroelastotic layer, and a smooth muscle layer. Twelve patients (63%) had aortic regurgitation, which necessitated repair or replacement in seven. Septal myectomy resulted in conduction abnormalities in nine.


CONCLUSIONS
The study describes the occurrence of DSM in adults. It is important to remember that it can occur following a repair of underlying congenital heart disease.
Butany
Jagdish
J
Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada. jagdish.butany@uhn.on.ca
Vaideeswar
Pradeep
P
David
Tirone E
TE
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000209:etiology; D006348:Cardiac Surgical Procedures; D003094:Collagen / Q000032:analysis; D021922:Discrete Subaortic Stenosis / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004417:Dyspnea / Q000209:etiology; D004730:Endothelium, Vascular / Q000473:pathology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006025:Glycosaminoglycans / Q000032:analysis; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D009130:Muscle, Smooth / Q000473:pathology; D009206:Myocardium / Q000737:chemistry / Q000473:pathology*
D006025:Glycosaminoglycans; D003094:Collagen