PMC8648471_01
Mid epigastric short axis view. The closed aortic valve is demonstrating the characteristic X pattern as seen in QAVs in a TEE. The incomplete closure is marked with a star, leading to significant aortic regurgitation.
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In order to delineate the pathology and severity of the regurgitation, a transesophageal echocardiogram (TEE) was performed and showed an aortic valve morphology suspicious for a quadricuspid aortic valve (Figure 1).
Mid Epigastric Short Axis View. During systole, 4 areas of commissural cusps fusion are noted (circled), suggesting aortic stenosis.
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The valve demonstrated doming and four areas of commissural fusion were noted (Figure 2).
Mid epigastric long axis view. In Figure 3, aortic valve doming is seen during midsystole, suggesting asymmetry and restriction. In Figure 4, taken with doppler ultrasonography during middiastole, a "mosaic pattern" (star) is evident in the left ventricular area, suggesting aortic regurgitant flow.
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The aortic root was mildly enlarged at 4.51 cm (Figure 3). The presence of a systolic aortic cusp doming also suggested a superimposed aortic stenosis (Figure 3).
Mid epigastric long axis view. In Figure 3, aortic valve doming is seen during midsystole, suggesting asymmetry and restriction. In Figure 4, taken with doppler ultrasonography during middiastole, a "mosaic pattern" (star) is evident in the left ventricular area, suggesting aortic regurgitant flow.
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There was holodiastolic flow reversal noted at the proximal descending aorta which helped to support severe regurgitation (Figures 4 and 5).
Descending aorta long axis view. In this image, a holosystolic aortic regurgitation is shown by the waveform labeled "I."
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There was holodiastolic flow reversal noted at the proximal descending aorta which helped to support severe regurgitation (Figures 4 and 5).