Quadricuspid aortic valve: an unexpected echocardiographic finding.

Abstract

Quadricuspid aortic valve (QAV) is an anatomic valvular variant, with a prevalence of 0.008% to 0.033% in the general population, and 1.46% in patients that undergo aortic valve replacement. The QAV can be an isolated valvular abnormality or associated with other congenital heart defects. In this article, we present three of the few reported cases of QAV in the Hispanic population, all of which were asymptomatic and without evidence of hemodynamic alterations or other associated heart defects. Additionally a literature review is provided.

Type A Quadricuspid Aortic Valve Infective Endocarditis Complicated by Multiple Aortocardiac Fistulae: Case Report and Brief Literature Review

“…However, thanks to advances in cardiac imaging technics, more cases have been reported. It is more often than not a solitary abnormality but is associated with patent ductus arteriosus, ventricular septal defect, pulmonary stenosis, hypertrophic cardiomyopathies, subvalvular and supravalvular aortic stenosis with left coronary atresia, and coronary ostia obstruction in nearly 10% of the cases [7]. AR is the most frequent complication of QAV accounting for 75% of the cases, where 9% have both aortic stenosis and regurgitation (isolated aortic stenosis is very rare) and 16% have normal-functioning QAVs [6, 8].…”

“…Echocardiography, especially TEE, is the preferred imaging technique for the detection of aortocardiac fistulae and QAV [4, 7]. Echocardiographic high diagnostic performance for aortocardiac fistulae is explained by the significant pressure gradient between the aorta and the cardiac chamber, which results in a highly turbulent flow across the fistulous formation readily detectable by continuous and color Doppler mapping even in the case of small fistulas [4].…”

“…Echocardiographic high diagnostic performance for aortocardiac fistulae is explained by the significant pressure gradient between the aorta and the cardiac chamber, which results in a highly turbulent flow across the fistulous formation readily detectable by continuous and color Doppler mapping even in the case of small fistulas [4]. In QAV, echocardiography shows an X-shaped pattern during diastole and a rhomboidal image in systole [7] (Figure 1). It is worth noting that in aortic IE, MSCT is an excellent imaging technique as it not only allows detection of abscesses/pseudoaneurysms—like in our case—with a similar diagnostic accuracy to TEE but also provides probably more information regarding the extent and consequences of any perivalvular extension, including the anatomy of pseudoaneurysms, abscesses, and fistulas.…”

Ischemic Stroke in a Patient With Quadricuspid Aortic Valve and Patent Foramen Ovale

“…We present a novel case of a patient with QAV and PFO, which has never been reported in the literature [4, 5, 8]. …”

“…Calcific valve disease of the left heart valves is classified as “low embolic risk” according to current guidelines. Nonetheless, it remains an important risk factor for cardiovascular events, including ischemic stroke [8]. …”