The probability of detecting a subaortic ridge in children with ventricular septal defect or coarctation of the aorta

Membranous subaortic stenosis can be found as an isolated congenital defect or in association with other congenital heart lesions such as ventricular septal defect (VSD)^1-7 or coarctation of the aorta (C of A).⁸ Recent reports have suggested an increased incidence of membranous subaortic stenosis in patients with VSD and right ventricular muscle bundles,⁹ malalignment VSD¹⁰ and ventricular septal aneurysm.^11-14 Membranous subaortic stenosis develops and progresses over time^15-17 and usually requires surgery. Subaortic stenosis is often associated with damage and thickening of the aortic valve, leading to aortic valve regurgitation.^18-20 In patients with VSD, ventricular septal aneurysm or C of A, we have observed an echogenic ridge of tissue in the left ventricular outflow tract that may be a precursor to membranous subaortic stenosis. To determine the probability of detecting a subaortic ridge in patients with VSD in different locations and in patients with C of A, and to determine if ventricular septal aneurysm increases the probability of detecting a subaortic ridge in patients with perimembranous VSD, we reviewed the echocardiographic records of our patients with VSD, subaortic ridge or C of A.