This is one of the images we were given from Wren's cath. It shows the obstructions that are causing most of the problem. The large fuzzy black shape on the lower left is Wren's left ventricle. The surgeon has drawn two lines across the space leading out of the ventricle and the aortic valve. This shows that the sub-aortic obstruction which makes the width of the outflow tract much narrower (5.6mm) than the valve (10.2mm).
The longer line shows the potential valve opening from the base of the leaflets but those two bumps under the longer line should not be there. Instead, that should be a straight channel going into the valve.
Again, above the valve there is a pinched hourglass with a big bump - a supra valvular obstruction. This also needs to be fixed.
Both these obstructions make Wren's left ventricle work much harder than it should. His LV pressure was 150 under sedation and Dr J estimated it would be in the 200's when active. He also suggested that Wren's mitral valve was not really exhibiting its true motion due to the high LV pressures. They recorded slightly increased pulmonary pressures too (new to us) which shows the mitral valve is also stenotic. Right now, data suggests it is mildly stenotic but the obstructions further down make this hard to evaluate and the doctors were cautiously suggesting it is moderately affected.
This leaves the surgical team a lot to talk about - definite work on sub-aortic stenosis and 'above valve' stenosis. Probably improving of aortic valve since OHS is happening anyway and possible dealing with mitral valve - decision to be made later.