Variable presentations manifesting outflow obstruction may lead to non-significant symptoms or produce symptoms linked to the degree of the left ventricular outflow tract obstruction. A patent ductus arteriosus is also an infrequent non-cyanotic congenital heart disease, which usually occurs as an isolated lesion, but in association with subaortic membrane, the prevalence is even lower. This combination affects the presentation, symptoms and management approach. Careful evaluation is important as the management strategy is based on the evaluation.
This is a case report, discussing a female patient in her middle-ages with subaortic membrane along with patent ductus arteriosus as a rare presentation. The electrocardiogram showed left ventricular hyper- trophy and strain pattern. The chest X-ray revealed cardiac enlargement with enlarged aorta. The echo- cardiography indicated a dilated left ventricle with mild left ventricular systolic dysfunction, a sub-aortic membrane with high gradient and moderate aortic regurgitation. There was also a PDA with a left to right shunt. The coronary angiogram indicated normal coronaries, and a large PDA. The right heart catheter pressure measurements revealed pulmonary hyper-tension. The patient infected with COVID-19 that had resulted in deterioration of her medical status and the planned management.
The combined lesion presents a challenging clinical presentation and diagnosis. Cardiac catheterization might be helpful. Management strategy might need modification. Exposure to COVID 19 infection compose a risk to such patient and influence the management strategy.
Key words: Ductus Arteriosus, Patent, Discrete Subaortic Stenosis, Heart failure, Case Reports, Hypertension, Pulmonary, Thoracic Surgery, Vascular Closure Devices