Sopek Merkaš I, Lakušić N, Paar MH. Quadricuspid aortic valve and right ventricular type of myocardial bridging in an asymptomatic middle-aged woman: A case report. World J Clin Cases 2022; 10(25): 8954-8961 [PMID: 36157661 DOI: 10.12998/wjcc.v10.i25.8954]
Corresponding Author of This Article
Nenad Lakušić, MD, PhD, Associate Professor, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Gajeva 2, Krapinske Toplice 49217, Croatia. nenad.lakusic@post.t-com.hr
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 6, 2022; 10(25): 8954-8961 Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8954
Quadricuspid aortic valve and right ventricular type of myocardial bridging in an asymptomatic middle-aged woman: A case report
Ivana Sopek Merkaš, Nenad Lakušić, Maja Hrabak Paar
Ivana Sopek Merkaš, Nenad Lakušić, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
Nenad Lakušić, Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
Nenad Lakušić, Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osjiek 31000, Croatia
Maja Hrabak Paar, Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Maja Hrabak Paar, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Sopek Merkaš I and Lakušić N were responsible for the conception and design of the manuscript, literature review, data collection, processing and wrote the first original draft; Lakušić N contributed in making critical revisions related to the important intellectual content of the manuscript; Hrabak Paar M analyzed and interpreted the CT imaging findings, literature review and made critical revisions related to the important intellectual content; All authors issued final approval for the version to be submitted.
Informed consent statement: The authors confirm that written consent for submission and publication of this case report including images and associated text have been obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nenad Lakušić, MD, PhD, Associate Professor, Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Gajeva 2, Krapinske Toplice 49217, Croatia. nenad.lakusic@post.t-com.hr
Received: January 23, 2022 Peer-review started: January 23, 2022 First decision: May 11, 2022 Revised: May 19, 2022 Accepted: July 27, 2022 Article in press: July 27, 2022 Published online: September 6, 2022 Processing time: 214 Days and 18.5 Hours
Abstract
BACKGROUND
Quadricuspid aortic valve (QAV) is a very rare congenital cardiac defect with the incidence of 0.0125%-0.033% (< 0.05%) predominantly causing aortic regurgitation. A certain number of patients (nearly one-half) have abnormal function and often require surgery, commonly in their fifth or sixth decade. QAV usually appears as an isolated anomaly but may also be associated with other cardiac congenital defects. Echocardiography is considered the main diagnostic method although more and more importance is given to computed tomography (CT) and magnetic resonance imaging (MRI) as complementary methods.
CASE SUMMARY
A 60-year-old female patient was referred for transthoracic ultrasound of the heart as part of a routine examination in the treatment of arterial hypertension. She did not have any significant symptoms. QAV was confirmed and there were no elements of valve stenosis with moderate aortic regurgitation. At first, it seemed that in the projection of the presumed left coronary cusp, there were two smaller and equally large cusps along with two larger and normally developed cusps. Cardiac CT imaging was performed to obtain an even more precise valve morphology and it showed that the location of the supernumerary cusp is between the right and left coronary cusp, with visible central malcoaptation of the cusps. Also, coronary computed angiography confirmed the right-type of myocardial bridging at the distal segment of the left anterior descending coronary artery. Significant valve dysfunction often occurs in middle-aged patients and results in surgical treatment, therefore, a 1-year transthoracic echocardiogram control examination and follow-up was recommended to our patient.
CONCLUSION
This case highlights the importance of diagnosing QAV since it leads to progressive valve dysfunction and can be associated with other congenital heart defects which is important to detect, emphasizing the role of cardiac CT and MRI.
Core Tip: The recognition of quadricuspid aortic valve (QAV) has clinical significance as it leads to progressive aortic valve dysfunction (aortic regurgitation in the majority), which can be severe enough for surgical correction and can be associated with other congenital heart defects - in our case, right-ventricular type of myocardial bridging at the distal segment of the left anterior descending coronary artery. Therefore, these patients require appropriate diagnosis, careful clinical evaluation and follow-up in order to be properly treated. Cardiac computed tomography, as well as magnetic resonance, is a useful imaging modality for comprehensively assessing of QAV.
