Combined Aortic and Pulmonic Stenosis

Abstract

Combined aortic and pulmonic stenosis is a rare lesion. The clinical, hemodynamic, and pathologic findings in four patients are presented. The presence of a forceful left as well as right ventricular impulse (in four patients), the difference in the character of the ejection murmur at the second left as opposed to the second right interspace (in two patients), and a diastolic rumble at the apex (in four patients) were characteristic. The electrocardiogram showed right ventricular hypertrophy in all patients; additional and definite left ventricular hypertrophy was found in one. Radiologically, there was evidence of right ventricular enlargement in all and suggestive left ventricular enlargement in three. Simple valvular stenosis of both valves was found in only one patient, and valvular pulmonary and supravalvular aortic stenosis in another. The two remaining patients, those with corrected transposition of the great arteries, had complicated lesions including a single ventricle in one and small ventricular septal defect in the other.Attempts at surgical correction were unsuccessful in all cases.