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DIAGNOSIS: CONGENITAL QUADRICUSPID AORTIC VALVE WITH ANOMALOUS ORIGIN OF LEFT CORONARY OSTIA

T c a e 1 A65-YEAR-OLD MAN presented to the authors’ institution for the evaluation of progressive dyspnea and angina on xertion. On physical examination, his blood pressure was 60/90 mmHg with a heart rate of 90 beats/min. Cardiac uscultation revealed a grade 4 early diastolic murmur at the nd right intercostal space. The electrocardiogram showed inus rhythm with left ventricular hypertrophy. Transthoacic echocardiography (TTE) revealed moderately severe ortic regurgitation, mild mitral regurgitation, thickened inerventricular septum (15 mm), and concentric left ventriclar hypertrophy with an ejection fraction of 53%. Furtherore, it showed a left ventricular end-diastolic dimension of 0 mm and an end-systolic dimension of 32 mm. A cardiac atheterization study showed triple-vessel coronary artery isease, and pressure data revealed the left ventricular presure of 180/18 mmHg and aortic pressure of 180/70 mmHg.