First quadricuspid aortic valve to be reported in Croatia

Area of Science:

• Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Quadricuspid aortic valve (QAV) is a rare congenital malformation.
• It can lead to aortic incompetence, often requiring surgical intervention in the 5th or 6th decade.
• Diagnosis can be challenging, sometimes missed by standard imaging techniques.

Observation:

• A 70-year-old woman presented with exertional dyspnea.
• Diagnostic workup included transthoracic ultrasound, CT scan, and coronary angiography with aortography.
• The unusual aortic valve anatomy was not identified preoperatively.

Findings:

• The patient's exertional dyspnea was attributed to aortic incompetence.
• Despite comprehensive preoperative imaging, the quadricuspid aortic valve malformation was not diagnosed.
• Intraoperative findings confirmed the congenital anomaly.

Implications:

• This case highlights the potential for missing rare congenital cardiac malformations like QAV, even with modern diagnostic tools.
• Early and accurate diagnosis is crucial for timely surgical intervention and improved patient outcomes.
• Intraoperative diagnosis remains vital for certain complex cardiac anomalies.