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Caivano D, Cicogna M, Orvieto S, Spitale D, Porciello F. Quadricuspid aortic valve in a 16-year-old Quarter horse. J Equine Vet Sci 2024; 142:105199. [PMID: 39306145 DOI: 10.1016/j.jevs.2024.105199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/20/2024] [Accepted: 09/17/2024] [Indexed: 09/27/2024]
Abstract
A 16-year-old horse, 400 kg, male, Quarter horse gelding was examined for a cardiac murmur that had not been previously heard. Physical examination revealed a regularly irregular pulse and a grade III/VI, decrescendo, diastolic murmur with a point of maximum intensity over the left heart base. Base-apex standard electrocardiographic examination at rest showed sinus rhythm with second-degree atrio-ventricular blocks. Echocardiography identified the presence of four aortic valve cusps, two equal larger and two unequal smaller cusps. Color flow Doppler examination showed a diastolic regurgitant jet emerging from the central region of closed aortic valve. Based on clinical and echocardiographic findings a diagnosis of mild to moderate aortic valve insufficiency secondary to quadricuspid aortic valve was made. This report describes a rare congenital heart defect that can be detected by transthoracic echocardiography in the horse.
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Affiliation(s)
- D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126, Italy.
| | - M Cicogna
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126, Italy
| | - S Orvieto
- Private Practitioner, Perugia, Italy
| | - D Spitale
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126, Italy
| | - F Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126, Italy
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2
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Shekiladze N, Murphy A, Babaliaros V, Ueyama H, Greenbaum A, Gleason P, Xie J. Can We Six It? Double BASILICA Transcatheter Aortic Valve Replacement in Quadricuspid Aortic Valve. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101352. [PMID: 39132463 PMCID: PMC11308060 DOI: 10.1016/j.jscai.2024.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 08/13/2024]
Abstract
Coronary artery obstruction is an uncommon yet devastating complication of transcatheter aortic valve replacement (TAVR) and may necessitate leaflet modification. A 38-year-old man presented to our center with quadricuspid aortic valve with severe aortic regurgitation. Double leaflet modification was performed with the Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) technique prior to TAVR, creating 6 leaflets from 4. The patient tolerated the procedure well with symptomatic improvement. Follow-up transthoracic echocardiogram showed normal bioprosthetic aortic valve function. This case demonstrates feasibility of this procedure with comprehensive preprocedural analysis and intraprocedural imaging guidance.
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Affiliation(s)
| | | | - Vasilis Babaliaros
- Division of Interventional Cardiology, Structural Heart & Valve Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Hiroki Ueyama
- Division of Interventional Cardiology, Structural Heart & Valve Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Adam Greenbaum
- Division of Interventional Cardiology, Structural Heart & Valve Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Patrick Gleason
- Division of Interventional Cardiology, Structural Heart & Valve Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Joe Xie
- Division of Interventional Cardiology, Structural Heart & Valve Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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3
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Sopek Merkaš I, Lakušić N, Paar MH. Quadricuspid aortic valve and right ventricular type of myocardial bridging in an asymptomatic middle-aged woman: A case report. World J Clin Cases 2022; 10:8954-8961. [PMID: 36157661 PMCID: PMC9477056 DOI: 10.12998/wjcc.v10.i25.8954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/19/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Quadricuspid aortic valve (QAV) is a very rare congenital cardiac defect with the incidence of 0.0125%-0.033% (< 0.05%) predominantly causing aortic regurgitation. A certain number of patients (nearly one-half) have abnormal function and often require surgery, commonly in their fifth or sixth decade. QAV usually appears as an isolated anomaly but may also be associated with other cardiac congenital defects. Echocardiography is considered the main diagnostic method although more and more importance is given to computed tomography (CT) and magnetic resonance imaging (MRI) as complementary methods.
CASE SUMMARY A 60-year-old female patient was referred for transthoracic ultrasound of the heart as part of a routine examination in the treatment of arterial hypertension. She did not have any significant symptoms. QAV was confirmed and there were no elements of valve stenosis with moderate aortic regurgitation. At first, it seemed that in the projection of the presumed left coronary cusp, there were two smaller and equally large cusps along with two larger and normally developed cusps. Cardiac CT imaging was performed to obtain an even more precise valve morphology and it showed that the location of the supernumerary cusp is between the right and left coronary cusp, with visible central malcoaptation of the cusps. Also, coronary computed angiography confirmed the right-type of myocardial bridging at the distal segment of the left anterior descending coronary artery. Significant valve dysfunction often occurs in middle-aged patients and results in surgical treatment, therefore, a 1-year transthoracic echocardiogram control examination and follow-up was recommended to our patient.
CONCLUSION This case highlights the importance of diagnosing QAV since it leads to progressive valve dysfunction and can be associated with other congenital heart defects which is important to detect, emphasizing the role of cardiac CT and MRI.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osjiek 31000, Croatia
| | - Maja Hrabak Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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4
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Seecheran RV, Seecheran VK, Persad SA, Rampersad F, Maharaj P, Khan S, Seecheran NA. The Quandary of the Quadricuspid Aortic Valve-The "Unlucky" 4-Leaf Clover: Case Report and Brief Clinical Review. J Investig Med High Impact Case Rep 2021; 8:2324709620921626. [PMID: 32389028 PMCID: PMC7370807 DOI: 10.1177/2324709620921626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The quadricuspid aortic valve is an exceedingly rare congenital valvular anomaly,
characterized by a tetrad of leaflets that typically presents with aortic
regurgitation. Almost one third of cases are associated with coexisting cardiac
defects with one fifth warranting surgical intervention. In this article, we
describe the first documented-in-Caribbean case and present a brief clinical
review of its pathophysiology, diagnosis, and management.
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Affiliation(s)
| | | | | | - Fidel Rampersad
- University of the West Indies, St. Augustine, Trinidad and Tobago
| | | | - Shari Khan
- North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
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Piracha UG, Kowlgi GN, Paulsen W, Mojadidi MK, Patel N. Quadricuspid aortic valve: a case report and review of literature. Future Cardiol 2021; 17:833-840. [PMID: 33463363 DOI: 10.2217/fca-2020-0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Quadricuspid aortic valve, a rare congenital cardiac defect, manifests most commonly as aortic regurgitation. Clinical presentation mainly depends on the functional status of the aortic valve, myocardium and associated cardiovascular abnormalities. Aortic valve replacement or repair is usually warranted in the 5th or 6th decade.
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Affiliation(s)
- Usman Ghani Piracha
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Walter Paulsen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA
| | | | - Nimesh Patel
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA
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Douglas A, Patel A, Batsides G, Safi L. Quadricuspid Aortic Valve: A Rare Cause of Aortic Regurgitation. CASE (PHILADELPHIA, PA.) 2020; 4:244-247. [PMID: 32875189 PMCID: PMC7451882 DOI: 10.1016/j.case.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
• Quadricuspid aortic valve is a rare finding in patients with aortic valvulopathy. • Patients over age 40 with this finding are more likely to have valve dysfunction. • Transesophageal echocardiogram is preferred to evaluate quadricuspid aortic valves.
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Affiliation(s)
- Analise Douglas
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | - George Batsides
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Lucy Safi
- Hackensack University Medical Center, Hackensack, New Jersey
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7
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Quadricuspid Aortic Valve: Report of Two Cases and Brief Review. Case Rep Cardiol 2019; 2019:7835287. [PMID: 31093380 PMCID: PMC6481097 DOI: 10.1155/2019/7835287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital cardiac defect characterized by the presence of four aortic valve leaflets of equal or varying sizes. Even rarer is its clinical presentation with aortic stenosis. Diagnosis of QAV could be challenging but is of great importance as patients often present with progressive aortic regurgitation. We present 2 cases of QAV presenting differently: one with aortic stenosis requiring valve replacement and the other with aortic regurgitation requiring close monitoring.
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Tsugu T, Murata M, Endo J, Kawakami T, Tsuruta H, Itabashi Y, Fukuda K. Long-term outcomes in 3 cases of quadricuspid aortic valve, using a new classification system: A case series and literature review. Echocardiography 2019; 36:595-597. [DOI: 10.1111/echo.14278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/07/2018] [Accepted: 01/15/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Toshimitsu Tsugu
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Mitsushige Murata
- Center for Preventive Medicine; Keio University School of Medicine; Tokyo Japan
| | - Jin Endo
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Takashi Kawakami
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Hikaru Tsuruta
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Yuji Itabashi
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
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9
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Choji CL, Selvaraj N, Prather J. Female Adolescent With Quadricuspid Aortic Valve. J Osteopath Med 2016; 115:570-2. [PMID: 26322936 DOI: 10.7556/jaoa.2015.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Quadricuspid aortic valve is a rare congenital heart defect. The authors present a case of this anomaly in a young, asymptomatic adolescent who presented to the echocardiography laboratory for further evaluation of a cardiac murmur detected on routine physical examination. Imaging revealed a quadricuspid aortic valve with aortic regurgitation. This case highlights the importance of auscultation in detecting cardiac abnormalities.
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10
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Vasudev R, Shah P, Bikkina M, Shamoon F. Quadricuspid Aortic Valve: A Rare Congenital Cause of Aortic Insufficiency. J Clin Imaging Sci 2016; 6:10. [PMID: 27195176 PMCID: PMC4860453 DOI: 10.4103/2156-7514.179417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/18/2016] [Indexed: 01/19/2023] Open
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly causing aortic regurgitation usually in the fifth to sixth decade of life. Earlier, the diagnosis was mostly during postmortem or intraoperative, but now with the advent of better imaging techniques such as transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases are being diagnosed in asymptomatic patients. We present a case of a 39-year-old male who was found to have QAV, with the help of TEE, while undergoing evaluation for a diastolic murmur. The patient was found to have Type B QAV with moderate aortic regurgitation. We also present a brief review of classification, pathophysiology, and embryological basis of this rare congenital anomaly. The importance of diagnosing QAV lies in the fact that majority of these patients will require surgery for aortic regurgitation and close follow-up so that aortic valve replacement/repair is done before the left ventricular decompensation occurs.
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Affiliation(s)
- Rahul Vasudev
- Department of Internal Medicine, St. Joseph's Regional Medical Center, 07503 NJ, USA
| | - Priyank Shah
- Department of Cardiology, St. Joseph's Regional Medical Center, 07503 NJ, USA
| | - Mahesh Bikkina
- Department of Cardiology, St. Joseph's Regional Medical Center, 07503 NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, St. Joseph's Regional Medical Center, 07503 NJ, USA
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11
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Uspenskiy VE, Osadchii AM, Gordeev ML. Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation: A Report of Four Cases. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:187-90. [PMID: 27390747 DOI: 10.12945/j.aorta.2015.15.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/25/2015] [Indexed: 11/18/2022]
Abstract
The 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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Affiliation(s)
- Vladimir E Uspenskiy
- Department of Cardiothoracic Surgery, Northwest Federal Medical Research Centre, Saint Petersburg, Russia
| | - Alexei M Osadchii
- Department of Cardiothoracic Surgery, Northwest Federal Medical Research Centre, Saint Petersburg, Russia
| | - Mikhail L Gordeev
- Department of Cardiothoracic Surgery, Northwest Federal Medical Research Centre, Saint Petersburg, Russia
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12
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Kanda H, Kunisawa T, Iida T, Kanao M, Toyama Y, Iwasaki H. Quadricuspid aortic valve detected by three-dimensional transesophageal echocardiography. J Cardiothorac Vasc Anesth 2015; 29:e33-5. [PMID: 25847413 DOI: 10.1053/j.jvca.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi, Asahikawa, Hokkaido, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi, Asahikawa, Hokkaido, Japan
| | - Takafumi Iida
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi, Asahikawa, Hokkaido, Japan
| | - Megumi Kanao
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi, Asahikawa, Hokkaido, Japan
| | - Yuki Toyama
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi, Asahikawa, Hokkaido, Japan
| | - Hiroshi Iwasaki
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi, Asahikawa, Hokkaido, Japan
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13
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Savino K, Quintavalle E, Ambrosio G. Quadricuspid Aortic Valve: A Case Report and Review of the Literature. J Cardiovasc Echogr 2015; 25:72-76. [PMID: 28465938 PMCID: PMC5353411 DOI: 10.4103/2211-4122.166077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The quadricuspid aortic valve (QAV) is a rare malformation; often isolated, sometimes associated with other heart diseases. Before the era of echocardiography, the diagnosis was made incidentally at autopsy or during surgery of valve replacement. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic approach is suitable for the diagnosis but, transesophageal echocardiography is a tool for the accurate definition of the valve anatomy. This review analyzes, after the presentation of a clinical case, the current knowledge on embryogenesis, classification, diagnosis and clinical course of QAV.
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Affiliation(s)
- Ketty Savino
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Elisa Quintavalle
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Giuseppe Ambrosio
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
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14
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Masuda H, Nakamura T, Mouri N, Sawa Y. Aortic valve replacement for quadricuspid valve: a lesson learnt from a negative experience. Interact Cardiovasc Thorac Surg 2014; 19:334-5. [PMID: 24824494 DOI: 10.1093/icvts/ivu105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Quadricuspid aortic valve is a rare congenital abnormality often associated with valve incompetence and requires surgical correction in adulthood. However, using a standard suture technique of aortic valve replacement, postoperative complete atrioventricular block is not uncommon because of the downward displacement of the supranumerary leaflet towards the membranous septum. We describe a suture technique where the sutures on the supranumerary leaflet were passed through the aortic sinusal wall above the valvar hinge. This technique can preclude injury to the conduction system, thereby avoiding atrioventricular block.
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Affiliation(s)
- Hirotada Masuda
- Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Teruya Nakamura
- Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Norio Mouri
- Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Yoshiki Sawa
- Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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15
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Monigari N, Poondru RR, Kareem H, Devasia T. Quadricuspid aortic valve: a rare congenital cardiac anomaly. BMJ Case Rep 2014; 2014:bcr-2014-204162. [PMID: 24748144 DOI: 10.1136/bcr-2014-204162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Naresh Monigari
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
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