Combined Supravalvular Aortic and Pulmonic Stenosis.

SIGNIFICANT outflow obstruction of both ventricles on a congenital basis is rare. Only 11 cases have been reported1-7 and, in most instances, the stenosis was either valvular or subvalvular on both sides. Supravalvular stenosis occurring in the pulmonary arteries or in the root of the aorta, although uncommon, has been reported frequently in recent years. The association of these two lesions in the same patient, however, has not, to our knowledge, been previously described. Two unusual cases recently reported by Soulie and co-workers" involved the coexistence of stenosis or hypoplasia of the primary pulmonary artery branches and hypoplasia of the thoracic and abdominal aorta, in the absence of supravalvular aortic stenosis. These authors also mention a similar case reported by Bulgarelli9 in which narrowing of the main pulmonary artery and its branches was associated with hypoplasia of the entire aorta. The purpose of this report is to describe the combination of supravalvular aortic stenosis and postvalvular pulmonic stenosis seen in three patients during the past 3 years and to stress the common features of the two conditions. Case Reports Case 1 S.M., a 16-year-old boy, was admitted to the hospital in February 1960, complaining of marked diminution of his exereise tolerance because of dyspnea, fatigue, cough, and hemoptysis. A heart murmur had been discovered at the age of 18 months, following an attack of eyanosis. At the age of 10 years, he began to experience dyspnea upon moderate exertion. After the age of 13, he was unable to participate in competitive athletics. Five months prior to admission, after running 200 yards, he experienced intense dyspnea and gross hemoptysis. From then on, he had bouts of hemoptysis almost daily following slight exer-