PMC9871348_01
Electrocardiogram of a 2-month-old patient with non-ST elevation myocardial infarction. It demonstrates ST segment depression in leads I, II, and aVF, inferior leads (arrows). It also shows T-wave inversion in the precordial leads.
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There was profound ST segment depression in the anterolateral leads of the electrocardiogram suggestive of non-ST elevation myocardial infarction (Figure 1).
Parasternal short-axis view demonstrates quadricuspid leaflets with 3 equal leaflets and a smaller left posterior leaflet (arrow) entrapping the left coronary ostium. A, Anterior; AoV, aortic valve; L, left; LA, left atrium; PV, pulmonary valve.
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TTE demonstrated a QAV with an unusual appearance of the left coronary artery ostium guarded by a leaflet of the valve (Figure 2; Video 1).
Parasternal long-axis view demonstrates abnormal left posterior leaflet (arrow) entrapping left sinus of Valsalva. A, Anterior; Ao, aortic valve; LA, left atrium; LV, left ventricle; RV, right ventricle; S, superior.
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Parasternal short-axis view: two-dimensional image demonstrates quadricuspid leaflets with the smaller left posterior leaflet entrapping the left coronary ostium (white arrow). Color Doppler image demonstrates aliasing of flow as it crosses this rudimentary leaflet coursing to the left coronary artery (yellow arrow). A, Anterior; Ao, aortic valve; L, left; PV, pulmonary valve.
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Given the clearly delineated pathology seen with TTE (Figure 4) and the findings on cardiac computed tomography scan, invasive angiography was deemed unnecessary.