Rare cause of aortic regurgitation.

To cite: Arantes C, Salomé N, Salgado A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-216475 DESCRIPTION Quadricuspid aortic valve is a rare congenital anomaly with an estimated incidence of 0.008– 1.46%. It is often detected incidentally at the time of surgery or at autopsy; however, with advances in imaging techniques the diagnosis is easier and also made earlier. 3 We report the case of a 40-year-old man who was referred to our department for the evaluation of asymptomatic aortic regurgitation. He had history of hypertension and dyslipidaemia. On cardiac auscultation, a grade II/VI diastolic murmur was heard on the left sternal border; remainder physical examination was unremarkable. The transthoracic echocardiography showed mild left ventricular enlargement and aortic regurgitation grade III/IV; the aortic valve appeared abnormal with asymmetric cusps and possibly with one accessory cusp (figure 1). Transesophageal echocardiography revealed a quadricuspid asymmetric aortic valve with two equal larger cusps and two unequal smaller cusps (figure 2). This aspect was confirmed by MRI (figure 3 and video 1) and no other cardiac abnormality was found. Since the patient was asymptomatic, he was kept in regular follow-up to monitor progression of his aortic regurgitation and no specific treatment was indicated. This case demonstrated that the multimodality imaging approach is a valuable tool in the characterisation of the mechanism of valvular insufficiency and for a proper characterisation of the valve.