Quadricuspid Aortic Valve: Multimodality Imaging
Nagaraja Moorthy, Aditya Kapoor, Sudeep Kumar, Zafar Neyaz & Sandeep Jain Pediatric Cardiology ISSN 0172-0643 Volume 34 Number 4 Pediatr Cardiol (2013) 34:1059-1061 DOI 10.1007/s00246-012-0586-z
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Author's personal copy Pediatr Cardiol (2013) 34:1059–1061 DOI 10.1007/s00246-012-0586-z
IMAGES IN PEDIATRIC CARDIOLOGY
Quadricuspid Aortic Valve: Multimodality Imaging Nagaraja Moorthy • Aditya Kapoor • Sudeep Kumar • Zafar Neyaz • Sandeep Jain
Received: 16 September 2012 / Accepted: 26 October 2012 / Published online: 18 November 2012 Ó Springer Science+Business Media New York 2012
A 56-year-old man presented to the outpatient department with a history of atypical chest pain. He had no traditional risk factors. Cardiac auscultation revealed a 3/6 early diastolic murmur along the lower left sternal border. Electrocardiography was normal. Transthoracic echocardiography showed normal left-ventricular dimension with normal left-ventricular ejection fraction (55%). Transthoracic and transesophageal echocardiography showed unusual quadricuspid aortic valve with four equal size cusps (Fig. 1a, b, Video 1 in Supplementary material).Color Doppler examination showed mild central aortic regurgitation (Fig. 2a, b; Video 2 in Supplementary material). TEE in basal short-axis view clearly demonstrated anatomy of aortic valve. Three-dimensional TEE showed excellent visualization of aortic valve anatomy (Fig. 3a, b; Video 3 in Supplementary material). As a part of chest pain evaluation and to rule out associated coronary artery anatomy, the patient underwent 64-slice multidetector computed tomographic (CT) coronary angiography, which showed quadricuspid aortic valve with two separate origins of the right and left normal coronary arteries (Fig. 4a, b). Virtual intra-aortic endoscopy by multidetector CT showed a rare appearance of four equal-sized aortic cusps. The patient was advised to pursue medical follow-up.
Congenital quadricuspid aortic valve is an uncommon developmental abnormality and is usually diagnosed incidentally at autopsies or during cardiac surgery. With
Electronic supplementary material The online version of this article (doi:10.1007/s00246-012-0586-z) contains supplementary material, which is available to authorized users. N. Moorthy (&) A. Kapoor S. Kumar Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India e-mail:
[email protected] Z. Neyaz S. Jain Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Fig. 1 Mid-esophageal aortic valve short-axis TEE image obtained during early diastole (a) and systole (b) showing quadricuspid aortic valve with a slight central noncoaptation
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Fig. 2 TEE demonstrating with color Doppler examination during diastole (a) and systole (b) showing mild central aortic regurgitation
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Pediatr Cardiol (2013) 34:1059–1061
Fig. 3 Three-dimensional echocardiography showing quadricuspid aortic valve in diastole (a) and systole (b)
Author's personal copy Pediatr Cardiol (2013) 34:1059–1061
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advances in imaging techniques, this malformation has been identified more frequently by echocardiography and other imaging modalities. Although aortic stenosis is rare, aortic regurgitation is the dominant valvular dysfunction associated with quadricuspid aortic valve. This case demonstrates utility of different imaging modalities in the study of aortic valve abnormalities.
Fig. 4 CT coronary angiography demonstrating quadricuspid aortic valve anatomy with separate origins of coronaries (a). Virtual intraaortic endoscopy (b) by multidetector CT showing four equal-sized aortic cusps
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