A Quadricuspid Aortic Valve With Severe Aortic Regurgitation
A 51-year-old man was referred for evaluation of cardiovascular risk before surgery. He had no previous history of cardiovascular disease and he did not take any drugs. He complained, however, of recent exertional dyspnea without any angina. Examination revealed a diastolic aortic murmur, and his blood pressure was 150/70 mm Hg. Transthoracic echocardiography confirmed the existence of a central severe aortic regurgitation associated with left ventricular dilatation and decreased left ventricular ejection fraction. Sigmoid aortic valves were mildly thickened, without the usual Y-aspect closure. Transesophageal echocardiography (Figure, A and B) showed a quadricuspid aortic valve with 4 cusps of equal size and an incomplete juxtaposition of the cusps responsible for a huge central aortic regurgitation. This aspect was confirmed by computed tomography (Figure, C) and magnetic resonance imaging. The coronary angiogram was normal. No other cardiac abnormality was found. The patient underwent open-heart surgery (Figure, D), which consisted of an aortic valve replacement by a 2-leaflet mechanical prosthesis.
Six months after surgery, the patient is doing well, with normalization of the left ventricular size and function.
The online-only Data Supplement, consisting of movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/25/e642/DC1.