A Patient with Quadricuspid Aortic Valve and Ischemic Stroke
Maximillian Krisper1, Clemens Köhncke2, Felicitas Escher2
1Department of Cardiology, Charité, University Clinic Berlin, Berlin, Germany. Electronic correspondence: max.krisper@charite.de.
The Journal of Heart Valve Disease
|December 24, 2016
Summary
Quadricuspid aortic valve (QAV) is a rare congenital defect. This case highlights QAV with calcific disease as a potential cause of ischemic stroke, challenging current risk classifications.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Quadricuspid aortic valve (QAV) is a rare congenital heart defect, often associated with aortic regurgitation.
- Calcific valve disease is generally considered low embolic risk, but can be linked to cardiovascular events like stroke.
Observation:
- A 71-year-old woman presented with acute ischemic stroke symptoms, including aphasia and right-sided hemiparesis.
- Brain MRI confirmed acute infarction in the left middle cerebral artery territory.
- Transesophageal echocardiography identified a quadricuspid aortic valve with thickened, calcified leaflets and moderate aortic regurgitation.
Findings:
- The quadricuspid aortic valve showed symmetrical sclerosis and calcific deposits across all four equal-sized cusps.
- The aortic valve area was measured at 3.2 cm², with associated moderate aortic regurgitation.
Implications:
- This case suggests that calcific quadricuspid aortic valve disease may represent a higher embolic risk than currently recognized.
- It underscores the importance of thorough cardiac evaluation in patients with cryptogenic stroke, particularly those with congenital valve anomalies.
- Further research is warranted to re-evaluate embolic risk stratification for calcific valve disease in congenital conditions like QAV.
Related Concept Videos
01:17Ischemic Heart Disease: Overview
3.7K
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
3.7K
01:27Regulation of Stroke Volume
5.4K
The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
5.4K
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
731
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
731
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
4.0K
Cardiac output (CO), the amount of blood the heart pumps per minute, is a parameter in cardiovascular physiology determined by stroke volume and heart rate. Stroke volume, the amount of blood pushed from one of the ventricles per heartbeat, is influenced by preload, afterload, and contractility.
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
4.0K
01:15Aortic Regurgitation I: Introduction
1.0K
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
1.0K
01:22Mitral Stenosis I: Introduction
1.0K
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
1.0K