PMC3303489_01
(A and Movie 1) Short axis echocardiographic image of the quadricuspid aortic valve with movie. (B and Movie 2) Transesophageal image of the quadricuspid aortic valve with movie. (C) Normal left anterior descending, circumflex and right coronary arteries obviating the need for invasive coronary angiography.
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Transthoracic echocardiography showed severe aortic regurgitation and a quadricuspid aortic valve (Fig. 1A, Movie 1). A transesophageal echocardiogram was performed to better define the quadricuspid aortic valve (Fig. 1B Movie 2). Coronary arteries were normal with no calcified or non-calcified plaque (Fig. 1C).
(A and Movie 3) Diastolic images from cross sectional multiphase reconstruction demonstrating four instead of three leaflets. There is lack of co-adaption of the aortic valve in diastole indicative of aortic insufficiency. (B) Coronal view of the aortic valve in diastole demonstrating contrast contiguous between the aorta and left ventricle indicative of aortic insufficiency. (C and Movie 4) Post processed image of the cross-section using voxel to voxel alignment and a noise reduction algorithm revealing lack of co-adaption of the four leaflets in diastole. (D) Operative appearance of the quadricuspid aortic valve.
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A transesophageal echocardiogram was performed to better define the quadricuspid aortic valve (Fig. 1B Movie 2). Cardiac CT revealed a type E quadricuspid or Type III ("four-leaf clover") aortic valve, with three cusps of similar size and one smaller cusp. Cardiac CT also showed lack of co-adaption of the valve in diastole indicative, of aortic insufficiency (Fig. 2A and B, Movie 3). This technique tracks the movement of individual voxels through space and time in an attempt to reduce noise, improve motion coherence and functional analytics (Ziosoft Inc, USA) (Fig. 2C, Movie 4). Surgical photographs and in-vitro anatomic pathology exam confirmed the findings (Fig. 2D).