Aortic insufficiency in a patient with a quadricuspid aortic valve and abnormal left coronary ostium

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

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Quadricuspid aortic valve; a rare cause of aortic insufficiency

Heart ◽

10.1136/hrt.2007.125385 ◽

2008 ◽

Vol 94 (7) ◽

pp. 866-866

Author(s):

S Basavarajaiah ◽

R S Uberoi ◽

S Sharma

Keyword(s):

Aortic Valve ◽

Aortic Insufficiency ◽

Quadricuspid Aortic Valve

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Quadricuspid Aortic Valve With Aortic Insufficiency: Case Report and Review of the Literature

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2007.00399.x ◽

2007 ◽

Vol 22 (3) ◽

pp. 235-237 ◽

Cited By ~ 10

Author(s):

Natalie F. Holt ◽

Murali Sivarajan ◽

Divakar Mandapati ◽

Yevgeniy Printsev ◽

John A. Elefteriades

Keyword(s):

Case Report ◽

Aortic Valve ◽

Aortic Insufficiency ◽

Quadricuspid Aortic Valve ◽

Review Of The Literature

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Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation

Aorta ◽

10.12945/j.aorta.2015.15.004 ◽

2015 ◽

Vol 03 (06) ◽

pp. 187-190 ◽

Cited By ~ 1

Author(s):

Vladimir Uspenskiy ◽

Alexei Osadchii ◽

Mikhail Gordeev

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Insufficiency ◽

Computed Tomographic Angiography ◽

Aortic Dilatation ◽

Quadricuspid Aortic Valve ◽

Severe Aortic Regurgitation ◽

Computed Tomographic ◽

Tomographic Angiography

AbstractThe quadricuspid aortic valve is a very uncommon malformation associated with aortic insufficiency, aortic stenosis, endocarditis, and ascending aortic dilatation. We report four cases of this aortic valve malformation. One patient with severe aortic regurgitation and moderate aortic dilatation required aortic valve replacement. Three patients had mild or moderate aortic insufficiency combined with moderate ascending aortic dilatation. These patients were referred to follow-up. The presented cases demonstrate that this aortic valve malformation may not be as rare as it appears and that attention must be paid to any quadricuspid findings during computed tomographic angiography and echocardiography.

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Single coronary ostium in a patient with quadricuspid aortic valve combined with aneurysmal ascending aortic dilatation

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-017-0622-4 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Do Yeon Kim ◽

Hwan Wook Kim

Keyword(s):

Aortic Valve ◽

Aortic Dilatation ◽

Coronary Ostium ◽

Quadricuspid Aortic Valve ◽

Single Coronary Ostium

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Aortic Valve Replacement for Quadricuspid Aortic Valve Associated With Right Coronary Ostium Anomaly: a Case Report

10.21203/rs.3.rs-965180/v1 ◽

2021 ◽

Author(s):

Shigeto Tsuji ◽

Shogo Shimada ◽

Yoshifumi Itoda ◽

Haruo Yamauchi ◽

Minoru Ono

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Ventricular Myocardium ◽

Coronary Ostium ◽

Quadricuspid Aortic Valve ◽

Case Presentation ◽

Severe Aortic Regurgitation ◽

The Right ◽

Selection Of

Abstract Background: Quadricuspid aortic valve is a rare congenital heart disease that may be associated with coronary ostium anomalies. Care should be taken to avoid occluding or compressing the coronary ostium while performing aortic valve replacement.Case presentation: Herein, we report a case of a 59-year-old woman who underwent aortic valve replacement for a quadricuspid aortic valve with severe aortic regurgitation. Intraoperatively, the aortic valve had four cusps of almost equal size and the right coronary artery arose adjacent to one of the commissures. The annular stitches were placed in a non-everting mattress fashion with pledgets on the ventricular side, and stitches near the right coronary ostium were transitioned to the subannular ventricular myocardium to maintain the distance from the ostium. Further, we selected a small prosthesis because oversized prosthetic valve could potentially compress the right coronary ostium.Conclusions: While performing aortic valve replacement for a quadricuspid aortic valve associated with a right coronary ostium anomaly, careful selection of the size of the prosthesis and modification of the annular stitches are essential to prevent obstruction of the coronary ostium.

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