**Introduction/Hypothesis:**
Introduction
Quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by a fourth cusp on the aortic valve, often resulting in aortic regurgitation. While historically diagnosed at autopsy or intraoperatively, echocardiography now allows for earlier detection. QAV is usually an isolated finding, but can be linked with other congenital defects, including patent ductus arteriosus and thoracic aortic aneurysm.

**Methods**
N/A

**Results**
Case Presentation
A 60-year-old male with hypertension, hyperlipidemia, and chronic kidney disease presented with progressive dyspnea, orthopnea, fatigue, and leg swelling. Physical examination was notable for an early diastolic decrescendo murmur, bilateral crackles, and peripheral edema. Laboratory tests were significant for elevated NT-pro BNP. Transthoracic echocardiography (TTE) showed a severely enlarged left ventricle and a quadricuspid aortic valve with regurgitation originating from a coaptation gap. Transesophageal echocardiography (TEE) confirmed QAV and severe aortic regurgitation (Figure 1). After a multidisciplinary discussion, the decision was to proceed with surgical intervention with aortic valve replacement with a 25 mm Inspiris bioprosthetic valve, as well as a 2-vessel coronary artery bypass graft due to significant coronary disease seen on preoperative coronary angiogram.

**Conclusion**
Discussion
QAV is a rare congenital defect with about 200 reported cases, manifesting typically in the fifth and sixth decades with a slight male predominance. It arises from abnormal embryonic development, leading to unequal shear stress and aortic regurgitation. Diagnosis relies on echocardiography, with TEE providing detailed imaging. Management of QAV involves monitoring and surgical intervention for symptomatic or severe cases. Aortic valve replacement is indicated for severe aortic regurgitation, with favorable long-term outcomes reported. Surgical strategies may include valve repair or replacement, with various techniques such as bicuspidization or tricuspidization tailored to specific valve morphology. This case highlights the importance of advanced imaging for accurate diagnosis and the role of comprehensive surgical planning and intervention.



**Introduction/Hypothesis:**
**Introduction**
Quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by a fourth cusp on the aortic valve, often resulting in aortic regurgitation. While historically diagnosed at autopsy or intraoperatively, echocardiography now allows for earlier detection. QAV is usually an isolated finding, but can be linked with other congenital defects, including patent ductus arteriosus and thoracic aortic aneurysm.

**Methods**
N/A

**Results**
**Case Presentation**
A 60-year-old male with hypertension, hyperlipidemia, and chronic kidney disease presented with progressive dyspnea, orthopnea, fatigue, and leg swelling. Physical examination was notable for an early diastolic decrescendo murmur, bilateral crackles, and peripheral edema. Laboratory tests were significant for elevated NT-pro BNP. Transthoracic echocardiography (TTE) showed a severely enlarged left ventricle and a quadricuspid aortic valve with regurgitation originating from a coaptation gap. Transesophageal echocardiography (TEE) confirmed QAV and severe aortic regurgitation (_Figure 1_). After a multidisciplinary discussion, the decision was to proceed with surgical intervention with aortic valve replacement with a 25 mm Inspiris bioprosthetic valve, as well as a 2-vessel coronary artery bypass graft due to significant coronary disease seen on preoperative coronary angiogram.

**Conclusion**
**Discussion**
QAV is a rare congenital defect with about 200 reported cases, manifesting typically in the fifth and sixth decades with a slight male predominance. It arises from abnormal embryonic development, leading to unequal shear stress and aortic regurgitation. Diagnosis relies on echocardiography, with TEE providing detailed imaging. Management of QAV involves monitoring and surgical intervention for symptomatic or severe cases. Aortic valve replacement is indicated for severe aortic regurgitation, with favorable long-term outcomes reported. Surgical strategies may include valve repair or replacement, with various techniques such as bicuspidization or tricuspidization tailored to specific valve morphology. This case highlights the importance of advanced imaging for accurate diagnosis and the role of comprehensive surgical planning and intervention.



Severe Aortic Regurgitation Due to Quadricuspid Aortic Valve with Associated Extensive Coronary Artery Disease

This course will explore basic and cutting-edge imaging techniques to improve patient care and hone individual skills in performance and interpretation of echocardiography, nuclear cardiology, cardiac computed tomography, and cardiovascular magnetic resonance imaging. Days will reinforce how cardiovascular imaging may improve comprehension in ischemic heart disease, structural heart disease, cardiomyopathies, and heart failure. Experts will utilize novel techniques to reinforce key topics including taped interventional cases and a strong emphasis on case presentations.