20-04-2011 | Imaging in Cardiology
Four leaf clover
Published in: Netherlands Heart Journal
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A 69-year-old male was evaluated for complaints of dyspnoea. Transthoracic echocardiography showed a moderate left ventricular systolic function. Although a significant aortic regurgitation was suspected, the valves could not be evaluated properly due to poor image quality. Consequently, transoesophageal echocardiography was performed which revealed a quadricuspid aortic valve (Fig. 1a and b). Only a moderate central aortic regurgitation was observed, valvular replacement was not indicated at the time. The ventricular dysfunction was found to be ischaemic of origin, the patient was treated successfully by percutaneous coronary intervention.
Fig. 1
a and b Transoesophageal echocardiographic short-axis view (60°) of the quadricuspid aortic valve, end-diastolic phase (a) and systolic phase (b). The aortic valve clearly consists of four symmetric cusps, giving the appearance of a four leaf clover. LA left atrium, RA right atrium, RV right ventricle, R right coronary cusp, L left coronary cusp, N non-coronary cusp, A accessory valve cusp
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