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).