Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography
A 52-year-old lady presented to our centre for echocardiogram from her primary-care-physician because he elicited a cardiac murmur. She had history of worsening breathlessness over a period of 7 years. She also had a history of pre-syncope.\nShe had a standard transthoracic echocardiogram (TTE), which revealed that her left ventricle (LV) is dilated with evidence of significant systolic dilatation (LV internal diameter systolic 55 mm) associated with severe systolic impairment with an ejection fraction of 33% (Simpson’s Bi-plane method). The aortic valve appeared to be bicuspid on sub-costal views. The parasternal views of the aortic valve were somewhat limited. There was evidence of severe aortic regurgitation (AR) with a central regurgitant jet, which occupied greater than 65% of the LV outflow tract and there was clear flow reversal in the aortic arch and descending aorta. In addition to these findings there is also mild mitral regurgitation (MR) and preserved right ventricular (RV) systolic function. She also informed us that mother had aortic root pathology and had to have aortic root replacement surgery. This hinted to hereditary congenital aortic or aortic valve pathology. She was admitted to our unit and received heart failure treatment and consequently had transoesopha-geal echocardiography (TOE) (Philips IE33 using 3D-TOE probe).