Evidence map›Paper›PMID 38812010›Full record

ArticleJournal of cardiothoracic surgery2024

Uncommon presentations of type A quadricuspid aortic valve in the Septuagenarian.

Perry Choi, Michael Paulsen, Yihan Lin, William Moskalik, Angela Ji, Ethan Jackson, Sachin Malik, Elan Burton, Y Joseph Woo, Thomas Burdon

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In one paragraph

Article in Journal of cardiothoracic surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Perry ChoiDepartment of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA.
Michael PaulsenDepartment of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA.
Yihan LinDepartment of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA.
William MoskalikDepartment of Cardiac Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Angela JiDepartment of Anesthesiology, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Ethan JacksonDepartment of Anesthesiology, Stanford University Medical Center, Palo Alto, CA, USA.
Sachin MalikDepartment of Radiology, Stanford University Medical Center, Palo Alto, CA, USA.
Elan BurtonDepartment of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA.
Y Joseph WooDepartment of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA.
Thomas BurdonDepartment of Cardiothoracic Surgery, Stanford University Medical Center, 300 Pasteur Drive Stanford, Stanford, CA, 94305, USA. burdon@stanford.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundQuadricuspid 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.

conclusionsQAV 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.

Indexed as

Aortic ValveAgedAortic Valve InsufficiencyAortic Valve StenosisEchocardiographyHeart Valve Prosthesis ImplantationHumansAortic stenosisAortic valve replacementFlail leafletQuadricuspid aortic valve

Identifiers

PMID38812010
PMCPMC11134947

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