Introduction
Quadricuspid aortic valve (QAV) is an exceedingly rare finding with a little more than 200 cases reported since 1862[1]despite recent advancement in cardiac imaging modalities. Although QAV has been reported in subjects presenting with no clinically significant symptoms, aortic insufficiency (of variable degree) due to malcoaptation, and subsequent complications remain the hall-mark clinic manifestation usually noted during the 4th decade and thereafter [ 2]. Case presentation
A 39-year-old male patient with no history of smoking was admitted to our department with a one-year history of progressive exertional chest tightness, which resolved after five to six minutes of resting. Chest auscultation uncovered a diastolic murmur at Erb’s point, while electrocardiogram performed at rest revealed no conduction abnormalities. His vitals measured as follows; pulse 68; respirations 17 and systolic blood pressure 132/72 mmHg.Transthoracic echocardiography during initial examination uncovered a QAV with severe regurgitation due to malcoaptation. Although presentation mimic coronary artery diseases, coronary angiography was not performed due to low suspicion index. Instead, computed tomography was performed to confirm the QAV structure and exclude associated cardiac lesions. The patient was scheduled for urgent elective aortic valve replacement.
Prior to valve replacement, intraoperative transoesophageal echocardiography was performed to delineate the following cardinal structures: aortic root, Sinus of Valsalva and Sino-tubular junction diameters, which measured :2.92cm,4.40cm and 3.48cm respectively. Additionally, the ejection fraction and the left ventricular end diastolic dimensions measured :57% and 7.1cm respectively. The static QAV imaging and intraoperative results are shown in (figure.1), and motion imaging results in (video.1 and video.2).