Quadricuspid aortic valve

A 57-year-old woman presented with a history of dyspnea on exertion since 4 months prior to admission. She denied chest pain. Her medical history was not significant. Physical exam-ination revealed wide pulse pressure and arterial hyperten-sion (170/65 mmHg). A diastolic murmur of grade 4/6 was heard at the left sternal border. ECG displayed sinus rhythm with evidence of left ventricular enlargement. Chest x-ray showed cardiomegaly. Review of previous trans-thoracic echocardiography of the patient, which was done 6 months earlier, revealed only moderate aortic regurgitation. Another echocardiography was done that revealed severe aortic regurgitation and normal appearing aortic valve. The patient underwent trans-esophageal echocardiography for detailed echocardiographic examination of the aortic valve and root. Interestingly, trans-esophageal echocardio-graphy showed a quadricuspid aortic valve with poor coapta-tion of aortic leaflets (Figure 1A–C) (see Movie Clip 1). Also, severe aortic regurgitation was detected (Figure 1D) (see Movie Clip 2). Quadricuspid aortic valve is a rare congenital heart defect and has been an incidental finding at open heart surgery or at autopsy.1 Hurwitz et al.2 introduced a classification nomenclature for quadricuspid aortic valve that included seven different types named A to G. Supplementary material Supplementary material associated with this article can be found in the online version