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Choi P, Paulsen M, Lin Y, Moskalik W, Ji A, Jackson E, Malik S, Burton E, Woo YJ, Burdon T. Uncommon presentations of type A quadricuspid aortic valve in the Septuagenarian. J Cardiothorac Surg 2024; 19:301. [PMID: 38812010 PMCID: PMC11134947 DOI: 10.1186/s13019-024-02696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/24/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by the presence of four cusps instead of the usual three. It is estimated to occur in less than 0.05% of the population, with Type A (four equal-sized leaflets) accounting for roughly 30% of QAV subtypes. Based on limited clinical series, the usual presentation is progressive aortic valve regurgitation (AR) with symptoms occurring in the fourth to sixth decade of life. Severe aortic valve stenosis (AS) and acute AR are very uncommon. CASE PRESENTATION We describe two cases of Type A QAV in patients who remained asymptomatic until their seventies with very uncommon presentations: one with severe AS and one with acute, severe AR and flail leaflet. In Case A, a 72-year-old patient with history of moderate AS presents to clinic with progressive exertional dyspnea. During work-up for transcatheter vs. surgical replacement pre-operative computed tomography angiogram (CTA) reveals a quadricuspid aortic valve with severe AS, and the patient undergoes surgical aortic valve replacement. Pre-discharge transthoracic echocardiography (TTE) shows good prosthetic valve function with no gradient or regurgitation. In Case B, a 76-year-old patient is intubated upon arrival to the hospital for acute desaturation, found to have wide open AR on catheterization, and transferred for emergent intervention. Intraoperative TEE reveals QAV with flail leaflet and severe AR. Repair is considered but deferred ultimately due to emergent nature. Post-operative TTE demonstrates good prosthetic valve function with no regurgitation and normal biventricular function. CONCLUSIONS QAV can present as progressive severe AS and acute AR, with symptoms first occurring in the seventh decade of life. The optimal treatment for QAV remains uncertain. Although aortic valve repair or transcatheter option may be feasible in some patients, aortic valve replacement remains a tenable option.
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Affiliation(s)
- Perry Choi
- Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA
- Department of Cardiac Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Michael Paulsen
- Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA
| | - Yihan Lin
- Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA
| | - William Moskalik
- Department of Cardiac Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Angela Ji
- Department of Anesthesiology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ethan Jackson
- Department of Anesthesiology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Sachin Malik
- Department of Radiology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Elan Burton
- Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA
- Department of Cardiac Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA
| | - Thomas Burdon
- Department of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA.
- Department of Cardiac Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA.
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Aquino-Bruno H, Muratalla-González R, Garcia-Garcia JF, Triano-Doroteo JL, Rivera KF, Balcarcel GC, Navarrete-Osuna M. Transcatheter aortic valve replacement planning with cardiac computed tomography in quadricuspid aortic valve stenosis: a case series. Eur Heart J Case Rep 2024; 8:ytae079. [PMID: 38405198 PMCID: PMC10894008 DOI: 10.1093/ehjcr/ytae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/21/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
Background The presence of severe aortic stenosis in quadricuspid aortic valve (QAV) is an extremely rare combination, and it is unknown whether transcatheter aortic valve replacement (TAVR) is a safe option due to the low incidence. Case summary We present two patients diagnosed with severe aortic stenosis with QAV morphology type 1 (Nakamura classification). All patients presented to our hospital for evaluation because of worsening functional class, dyspnoea, or syncope. During tomographic planning, the aortic annulus was measured at the level of the deepest sinus for the selection of the number of devices. Due to the presence of four cusps, the smallest cusp was excluded, and three sinuses were virtualized for placement of the pigtail catheter during the procedure. Without complications, a 23 mm Edwards SAPIEN 3 was deployed through the femoral artery in both patients. Control aortography showed no valve leakage or regurgitation. Discussion In patients with QAV and aortic stenosis undergoing TAVR, similar to the tricuspid valve, tomographic planning can be used to ensure the success of the procedure. However, unlike the tricuspid valve, where the selection of the device number is based on the measurements of the aortic annulus at the level of the non-coronary sinus, in these QAV cases, we perform the measurements at the level of the deepest aortic sinus (right coronary sinus).
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Affiliation(s)
- Heberto Aquino-Bruno
- Interventional Cardiology Service, Centro Medico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Roberto Muratalla-González
- Interventional Cardiology Service, Centro Medico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - Juan F Garcia-Garcia
- Interventional Cardiology Service, Centro Medico Nacional 20 de Noviembre, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico
| | - José L Triano-Doroteo
- Interventional Cardiology Service, Hospital Regional Culiacan ISSSTE, Sinaloa, Mexico
| | - Kevin Felix Rivera
- Interventional Cardiology Service, Hospital Regional Culiacan ISSSTE, Sinaloa, Mexico
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Machraa A, Bakamel L, Tagueniti J, Meftout B, Goube P. An Unlucky Four-Leaf Clover Stenosis With a Single Coronary Artery. Cureus 2024; 16:e51871. [PMID: 38327921 PMCID: PMC10849107 DOI: 10.7759/cureus.51871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
The recognition of quadricuspid aortic valve has clinical significance as it leads to aortic valve dysfunction. Due to its frequent association with other congenital cardiac abnormalities, such as abnormally located coronary ostia, preoperative diagnosis is crucial. We present the case of a unique association of quadricuspid aortic valve stenosis with a single coronary artery.
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Affiliation(s)
- Achraf Machraa
- Cardiac Catheterization Laboratory Unit, Department of Cardiology, Sud Francilien Hospital Center, Corbeil-Essonnes, FRA
| | - Lamyaa Bakamel
- Clinical Cardiology Unit, Department of Cardiology, Sud Francilien Hospital Center, Corbeil-Essonnes, FRA
| | - Jalal Tagueniti
- Cardiac Catheterization Laboratory Unit, Department of Cardiology, Sud Francilien Hospital Center, Corbeil-Essonnes, FRA
| | - Brahim Meftout
- Cardiac Catheterization Laboratory Unit, Department of Cardiology, Sud Francilien Hospital Center, Corbeil-Essonnes, FRA
| | - Pascal Goube
- Clinical Cardiology Unit, Department of Cardiology, Sud Francilien Hospital Center, Corbeil-Essonnes, FRA
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Chen Y, Ferdous MM, Kottu L, Zhao J, Zhang HL, Wang MY, Niu GN, Liu QR, Zhou Z, Zhao ZY, Zhang Q, Feng DJ, Zhang B, Li ZA, Merkus D, Lv B, Xu HY, Song GY, Wu YJ. Can Measuring the 'Dual Anchors of Aorta' Enhance the Success Rate of TAVR?-A Single-Center Experience. J Clin Med 2023; 12:jcm12031157. [PMID: 36769804 PMCID: PMC9918180 DOI: 10.3390/jcm12031157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Chronic severe aortic regurgitation (AR) has a poor long-term prognosis, especially among old-age patients. Considering their advancing age, the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients. Therefore, this study's primary goal was to provide an initial summary of the medium- and short-term clinical effectiveness of transcatheter aortic valve replacement (TAVR) guided by accurate multi-detector computed tomography (MDCT) measurements in patients with severe and chronic AR, especially in elderly patients. METHODS The study enrolled retrospectively and prospectively patients diagnosed with severe AR who eventually underwent TAVR procedure from January 2019 to September 2022 at Fuwai cardiovascular Hospital, Beijing. Baseline information, MDCT measurements, anatomical classification, perioperative, and 1-year follow-up outcomes were collected and analyzed. Based on a novel anatomical categorization and dual anchoring theory, patients were divided into four categories according to the level of anchoring area. Type 1, 2, and 3 patients (with at least two anchoring regions) will receive TAVR with a transcatheter heart valve (THV), but Type 4 patients (with zero or one anchoring location) will be deemed unsuitable for TAVR and will instead receive medical care (retrospectively enrolled patients who already underwent TAVR are an exception). RESULTS The mean age of the 37 patients with severe chronic AR was 73.1 ± 8.7 years, and 23 patients (62.2%) were male. The American Association of Thoracic Surgeons' score was 8.6 ± 2.1%. The MDCT anatomical classification included 17 cases of type 1 (45.9%), 3 cases of type 2 (8.1%), 13 cases of type 3 (35.1%), and 4 cases of Type 4 (10.8%). The VitaFlow valve (MicroPort, Shanghai, China) was implanted in 19 patients (51.3%), while the Venus A valve (Venus MedTech, Hangzhou, China) was implanted in 18 patients (48.6%). Immediate TAVR procedural and device success rates were 86.5% and 67.6%, respectively, while eight cases (21.6%) required THV-in-THV implantation, and nine cases (24.3%) required permanent pacemaker implantation. Univariate regression analysis revealed that the major factors affecting TAVR device failure were sinotubular junction diameter, THV type, and MDCT anatomical classification (p < 0.05). Compared with the baseline, the left ventricular ejection fraction gradually increased, while the left ventricular end-diastolic diameter remained small, and the N-terminal-pro hormone B-type natriuretic peptide level significantly decreased within one year. CONCLUSION According to the results of our study, TAVR with a self-expanding THV is safe and feasible for patients with chronic severe AR, particularly for those who meet the criteria for the appropriate MDCT anatomical classification with intact dual aortic anchors, and it has a significant clinical effect for at least a year.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Md Misbahul Ferdous
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Lakshme Kottu
- Department of Experimental Cardiology, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
| | - Hong-Liang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Mo-Yang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guan-Nan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Qing-Rong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zheng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zhen-Yan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Qian Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - De-Jing Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Zi-Ang Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Daphne Merkus
- Department of Experimental Cardiology, Erasmus University Medical Center, 3015 CE Rotterdam, The Netherlands
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-University München, 81377 Munich, Germany
| | - Bin Lv
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Hai-Yan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
| | - Guang-Yuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
| | - Yong-Jian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China
- Correspondence: (J.Z.); (G.-Y.S.); (Y.-J.W.)
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