Válvula aórtica quadricúspide – Casuística de 10 anos e revisão da literatura

Unicuspid and quadricuspid aortic valves: two case reports and literature review

There are three cusps in a normally developed aortic valve. Abnormal excavation or fusion, during the embryological development of the aortic valve, results in a varying number of cusps. Bicuspid aortic valve is the most common, but more rarely, unicuspid and quadricuspid aortic valves can be seen.Here, a case of a 16-year-old male with a unicommissural unicuspid aortic valve and a case of a 13-year-old female with a quadricuspid aortic valve were reported.

Prevalence, multimodality imaging characterization, and mid-term prognosis of quadricuspid aortic valves: an analysis of eight cases, based on 160 004 exams performed during 12 years in a tertiary care hospital

AIMS

Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) requiring surgical intervention in some patients. The characteristics associated with aortic valve functional degeneration in patients with QAV are still unknown. The aim of this study is to describe QAV prevalence, characterize the disease by multimodality imaging, evaluate predictors of severe AR, and assess mid-term prognosis.

METHODS AND RESULTS

Retrospective search in imaging exams database of one tertiary centre, for patients diagnosed with QAV between January 2007 and September 2019. QAV was characterized by cardiac computed tomography, transthoracic/transoesophageal echocardiography, and cardiac magnetic resonance. A total of 160 004 exams were reviewed and eight patients with QAV were identified (50% men, mean age 53.5 ± 10.7 years). The prevalence of QAV was 0.005%. During a median follow-up of 52 months (interquartile range 16-88), there were no deaths. Seven patients (88%) had pure AR (three severe, one moderate, and three mild) and one patient (12%) had moderate AR and moderate aortic stenosis. Three patients (38%) with severe AR underwent valve surgery (two replacements and one repair). Analysis of predictors of severe AR was not statistically significant.

CONCLUSION

QAV is a rare congenital cardiac defect, with a prevalence of 0.005% in our study. Its predominant functional abnormality was regurgitation and about one-third of the patients required aortic valve surgery. Multimodality imaging may play a pivotal role in assessing patients with QAV with significant valve dysfunction or associated congenital heart disease and improve their treatment strategy.

Quadricuspid Aortic Valve: Three Cases Report and Literature Review

Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts^[1], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.

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

Background

The presence of a fourth aortic valve cusp (quadricupsid aortic valve) is a rare congenital malformation and is often accompanied by other anomalies of the adjacent cardiovascular structures. Among these concomitant anomalies, simultaneous association of both a single coronary ostium and aneurysmal ascending aortic dilation in combination with the quadricupsid aortic valve has not been reported yet.

Case presentation

We experienced the case of a 56-year-old female patient presenting as aortic regurgitation resulted from malcoaptation of quadricupsid aortic valve. The patient had also accompanying aneurysmal ascending aortic dilatation and coronary ostial anomaly. Surgical correction (aortic valve replacement with mechanical devices and supracoronary aortic replacement with prosthetic graft) was performed without any complications.

Conclusions

The technological development of preoperative imaging studies enable the physician to encounter the quadricuspid aortic valve with other associated malformations more often unlike previous reports. With review on the quadricuspid aortic valve, we discussed a surgical considerations for the treatment of this anomaly.

Electronic supplementary material

The online version of this article (doi:10.1186/s13019-017-0622-4) contains supplementary material, which is available to authorized users.

Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.

Quadricuspid aortic valve diagnosed by multidetector computed tomography (MDCT)

A quadricuspid aortic valve is very rare form of congenital cardiac valvular disease with an incidence between 0.003 and 0.043% and often incidentally found during echocardiography, surgery or on post-mortem examination (Feldman BJ, Khandheria BK, Warnes CA, Seward JB, Taylor CL, Tajik AJ. Incidence, description and functional assessment of isolated quadricuspid aortic valves. Am J Cardiol 1990; 65 : 937-8). Its diagnosis is often missed, even with the transthoracic echocardiogram, as in this patient. We report a case of a quadricuspid aortic valve that was incidentally found by 256-slice electrographically-gated multidetector row CT/tomographic angiography during screening for coronary artery disease.

The quadricuspid aortic valve

The quadricuspid aortic valve is a very rare congenital defect that may be an isolated entity or associated with a multitude of cardiovascular abnormalities. Isolated cases usually manifest late in life with the complication of aortic regurgitation, which can be delayed by early valve replacement. We present a case of quadricuspid aortic valve associated with truncus arteriosus, ventricular septal defect, and interrupted aortic arch.

Imaging of cardiac valves by computed tomography

This paper describes "how to" examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, "how to" perform and optimize a multislice CT scan and "how to" interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide "how to" use CT for planning of transcatheter aortic valve implantation (TAVI), an emerging effective treatment option for patients with severe aortic stenosis. A special focus is placed on clinical applications of cardiac CT in the context of valvular disease.

Quadricuspid aortic valve with aortic regurgitation: a rare echocardiographic finding

We report on a middle-aged woman treated for chronic hepatitis C virus infection with pegylated interferon. Auscultation revealed a diastolic murmur and the peripheral signs of aortic regurgitation. She had shortness of breath on moderate exertion for the past 4 months, which she attributed to her liver disease. Echocardiogram showed a quadricuspid aortic valve with severe aortic regurgitation. She was referred to a cardiothoracic surgeon for aortic valve replacement (AVR). However, she decided against AVR despite detailed counselling, and opted for medical treatment.

Congenital quadricuspid pulmonary valve in an adult patient with double valvular lesions and poststenotic dilatation of the trunk and the left branch of the pulmonary artery: a case presentation and review of the literature

The quadricuspid pulmonary valve (QPV) is a rare congenital anomaly reported in the general population. There are less than 300 reported cases in the literature to date. It has been found in one in 400 to one in 2000 autopsies. We describe here the case of a 47-year-old patient who presents with a QPV with double valvular lesions (stenosis and insufficiency), causing a poststenotic dilatation of the trunk and the left branch of the pulmonary artery (PA). The diagnosis was made by transesophageal echocardiography (TEE) and confirmed by tomographic angiography (computed tomography). The English as well as the Spanish literature were reviewed. To the best of our knowledge, this is the first case of: (1) congenital QPV with double valvular lesions (stenosis and insufficiency), complicated with (2) aneurysmatic dilatation of the PA trunk as well as left branch, and (3) diagnosed by a TEE.