Transcatheter aortic valve replacement for quadricuspid aortic valve: a case report_West China Medical Journal

Authors：

CHEN Zhicheng , LI Yijian ,  FENG Yuan , ZHAO Zhengang , WEI Xin

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FENG Yuan, Email: fynotebook@hotmail.com

Keywords：

Quadricuspid aortic valve; aortic regurgitation; transcatheter aortic valve replacement; subaortic membrane

DOI：

10.7507/1002-0179.202408151

Video：

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Abstract Full text Figures/Tables Video References Cited by

Quadricuspid aortic valve (QAV) is a rare congenital heart disease, and its long-term lesion type is mainly reflux. The application of transcatheter aortic valve replacement (TAVR) in such patients is extremely rare. This article reports a case of an elderly patient with QAV complicated with severe regurgitation and small subvalvular membrane. Through preoperative evaluation and guidance from the cardiac team discussion, a relatively high oversize rate retrievable valve was selected and the TAVR surgery was successfully completed. At the same time, the valve implantation depth was adjusted to cover the subvalvular membrane. After surgery, the patient’s symptoms such as palpitations were significantly improved. No obvious perivalvular leakage or regurgitation was observed. It provides a reference for TAVR surgical plans for such patients.

1.	Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol, 1973, 31(5): 623-626.
2.	Alomari M, El-Sayed Ahmed MM, Ali M, et al. Quadricuspid aortic valve: imaging, diagnosis, and prognosis. Tex Heart Inst J, 2024, 51(1): e238256.
3.	Jagannath AD, Johri AM, Liberthson R, et al. Quadricuspid aortic valve: a report of 12 cases and a review of the literature. Echocardiography, 2011, 28(9): 1035-1040.
4.	Piracha UG, Kowlgi GN, Paulsen W, et al. Quadricuspid aortic valve: a case report and review of literature. Future Cardiol, 2021, 17(5): 833-840.
5.	Tsang MY, Abudiab MM, Ammash NM, et al. Quadricuspid aortic valve: characteristics, associated structural cardiovascular abnormalities, and clinical outcomes. Circulation, 2016, 133(3): 312-319.
6.	Suraci N, Horvath SA, Urina D, et al. Quadricuspid aortic valve: case series and review of literature. Echocardiography, 2019, 36(2): 406-410.
7.	Tutarel O. The quadricuspid aortic valve: a comprehensive review. J Heart Valve Dis, 2004, 13(4): 534-537.
8.	Timperley J, Milner R, Marshall AJ, et al. Quadricuspid aortic valves. Clin Cardiol, 2002, 25(12): 548-552.
9.	Seecheran RV, Seecheran VK, Persad SA, et al. The quandary of the quadricuspid aortic valve-the “unlucky” 4-leaf clover: case report and brief clinical review. J Investig Med High Impact Case Rep, 2020, 8: 2324709620921626.
10.	Idrees JJ, Roselli EE, Arafat A, et al. Outcomes after repair or replacement of dysfunctional quadricuspid aortic valve. J Thorac Cardiovasc Surg, 2015, 150(1): 79-82.
11.	Sohn J, Arain FD. Two consecutive cases of quadricuspid aortic valve and a review of 149 cases. J Cardiothorac Vasc Anesth, 2022, 36(3): 717-723.
12.	Tsugu T, Murata M, Endo J, et al. Long-term outcomes in 3 cases of quadricuspid aortic valve, using a new classification system: a case series and literature review. Echocardiography, 2019, 36(3): 595-597.
13.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e35-e71.
14.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. EuroIntervention, 2022, 17(14): e1126-e1196.
15.	Blanke P, Wengenmayer T, Sorg S, et al. Stenosed quadricuspid aortic valve treated by transcatheter aortic valve implantation. J Am Coll Cardiol, 2011, 57(14): 1567.
16.	Zhou D, Fan J, Liu X, et al. The first two cases of long-term outcomes after transcatheter aortic valve replacement in patients with quadricuspid aortic valve. J Invasive Cardiol, 2021, 33(10): E839-E840.
17.	Tohoku S, Shirai S, Hayashi M, et al. Successful transcatheter aortic valve implantation in a quadricuspid aortic valve with severe stenosis and moderate regurgitation. Cardiovasc Interv Ther, 2018, 33(4): 400-401.
18.	刘伟丽, 张岩, 江磊, 等. 经导管主动脉瓣置入术治疗单纯性四叶式主动脉瓣重度反流 1 例. 中国介入心脏病学杂志, 2020, 28(9): 535-536.
19.	Lake M, Lerakis S, Green J, et al. Ventricular noncompaction and associated cardiac anomalies. Am J Med Sci, 2010, 340(5): 399-401.

1. Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol, 1973, 31(5): 623-626.
2. Alomari M, El-Sayed Ahmed MM, Ali M, et al. Quadricuspid aortic valve: imaging, diagnosis, and prognosis. Tex Heart Inst J, 2024, 51(1): e238256.
3. Jagannath AD, Johri AM, Liberthson R, et al. Quadricuspid aortic valve: a report of 12 cases and a review of the literature. Echocardiography, 2011, 28(9): 1035-1040.
4. Piracha UG, Kowlgi GN, Paulsen W, et al. Quadricuspid aortic valve: a case report and review of literature. Future Cardiol, 2021, 17(5): 833-840.
5. Tsang MY, Abudiab MM, Ammash NM, et al. Quadricuspid aortic valve: characteristics, associated structural cardiovascular abnormalities, and clinical outcomes. Circulation, 2016, 133(3): 312-319.
6. Suraci N, Horvath SA, Urina D, et al. Quadricuspid aortic valve: case series and review of literature. Echocardiography, 2019, 36(2): 406-410.
7. Tutarel O. The quadricuspid aortic valve: a comprehensive review. J Heart Valve Dis, 2004, 13(4): 534-537.
8. Timperley J, Milner R, Marshall AJ, et al. Quadricuspid aortic valves. Clin Cardiol, 2002, 25(12): 548-552.
9. Seecheran RV, Seecheran VK, Persad SA, et al. The quandary of the quadricuspid aortic valve-the “unlucky” 4-leaf clover: case report and brief clinical review. J Investig Med High Impact Case Rep, 2020, 8: 2324709620921626.
10. Idrees JJ, Roselli EE, Arafat A, et al. Outcomes after repair or replacement of dysfunctional quadricuspid aortic valve. J Thorac Cardiovasc Surg, 2015, 150(1): 79-82.
11. Sohn J, Arain FD. Two consecutive cases of quadricuspid aortic valve and a review of 149 cases. J Cardiothorac Vasc Anesth, 2022, 36(3): 717-723.
12. Tsugu T, Murata M, Endo J, et al. Long-term outcomes in 3 cases of quadricuspid aortic valve, using a new classification system: a case series and literature review. Echocardiography, 2019, 36(3): 595-597.
13. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e35-e71.
14. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. EuroIntervention, 2022, 17(14): e1126-e1196.
15. Blanke P, Wengenmayer T, Sorg S, et al. Stenosed quadricuspid aortic valve treated by transcatheter aortic valve implantation. J Am Coll Cardiol, 2011, 57(14): 1567.
16. Zhou D, Fan J, Liu X, et al. The first two cases of long-term outcomes after transcatheter aortic valve replacement in patients with quadricuspid aortic valve. J Invasive Cardiol, 2021, 33(10): E839-E840.
17. Tohoku S, Shirai S, Hayashi M, et al. Successful transcatheter aortic valve implantation in a quadricuspid aortic valve with severe stenosis and moderate regurgitation. Cardiovasc Interv Ther, 2018, 33(4): 400-401.
18. 刘伟丽, 张岩, 江磊, 等. 经导管主动脉瓣置入术治疗单纯性四叶式主动脉瓣重度反流 1 例. 中国介入心脏病学杂志, 2020, 28(9): 535-536.
19. Lake M, Lerakis S, Green J, et al. Ventricular noncompaction and associated cardiac anomalies. Am J Med Sci, 2010, 340(5): 399-401.

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