Quadricuspid Aortic Valve: Characteristics, Associated Structural Cardiovascular Abnormalities, and Clinical Outcomes
Background—Quadricuspid aortic valve (QAV) is a rare congenital cardiac defect. This study sought to determine QAV frequency in a large echocardiography database, characterize associated cardiovascular abnormalities, and describe long-term outcomes.
Methods and Results—Fifty patients (age, mean [SD], 43.5 [21.8] years at the time of index diagnosis; female sex, 52%) received a diagnosis of QAV between January 1, 1975, and March 14, 2014 (frequency, 0.006%). The QAV was type A in 32% and type B in 32% (Hurwitz and Roberts classification). Aortic dilatation was present in 29% of the patients, and 26% had moderate or severe aortic valve regurgitation (AR) at index diagnosis. Stenosis affected only 8% of the valves and was mild. Other findings, including abnormalities of other cardiac valves, septal defects, persistent left superior vena cava, and patent ductus arteriosus, were present in 32% of patients. During a mean (SD) follow-up of 4.8 (5.6) years, 8 patients underwent aortic valve surgery, with severe AR being the surgical indication in 7 patients. One patient with mild to moderate AR underwent aortic valve repair for obstruction of the left coronary ostium by the accessory cusp of QAV. No infective endocarditis or aortic dissection was found. Overall survival was 91.5% and 87.7% at 5 and 10 years.
Conclusions—Aortic dilatation and other structural cardiac abnormalities were relatively common among patients with QAV. AR was the predominant hemodynamic abnormality and the indication for aortic valve surgery in most patients who received surgery. Long-term survival was excellent.
- Received May 29, 2015.
- Revision received November 17, 2015.
- Accepted November 25, 2015.