A man in his 60s was referred to our clinic as a part of preoperative evaluation for non-cardiac surgery. The patient did not have any cardiovascular symptoms and had never been evaluated previously. Examination revealed a low volume pulse and an ejection systolic murmur best heard in the left parasternal region. An early diastolic murmur was also heard. The ejection systolic murmur decreased in intensity with Valsalva manoeuvre. ### Question The transthoracic echocardiogram is shown in figure 1 (online supplemental video). What is the diagnosis? ### Supplementary video [heartjnl-2021-319841supp001.mp4] Figure 1 Transthoracic echocardiography (A) Apical five-chamber view. (B) Colour Doppler imaging. 1. Hypertrophic cardiomyopathy (HCM) 2. Valvular aortic stenosis 3. Supravalvular aortic stenosis 4. Subaortic membrane The echocardiogram shows a discrete subaortic membrane causing subvalvular aortic stenosis. The colour Doppler across aortic …

中文翻译：

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有射血性收缩期杂音的人

一名 60 多岁的男性被转诊到我们诊所，作为非心脏手术术前评估的一部分。该患者没有任何心血管症状，之前从未接受过评估。检查显示在左侧胸骨旁区域最好听到低容量脉冲和射血性收缩期杂音。还听到早期舒张期杂音。随着 Valsalva 动作，射血收缩期杂音的强度降低。### 问题 经胸超声心动图如图 1（在线补充视频）所示。诊断是什么？### 补充视频 [heartjnl-2021-319841supp001.mp4] 图 1 经胸超声心动图 (A) 心尖五腔视图。(B) 彩色多普勒成像。1. 肥厚型心肌病 (HCM) 2. 主动脉瓣狭窄 3. 主动脉瓣上狭窄 4. 主动脉下膜 超声心动图显示离散的主动脉下膜导致主动脉瓣下狭窄。横跨主动脉的彩色多普勒…