case_images: PMC8648471_01
case_images: Mid epigastric short axis view. The closed aortic valve is demonstrating the characteristic X pattern as seen in QAVs in a TEE. The incomplete closure is marked with a star, leading to significant aortic regurgitation.
case_images: CRIC2021-5596297.001.jpg
case_images: PMC8648471_01_CRIC2021-5596297.001.jpg
case_images: fig1
case_images: In order to delineate the pathology and severity of the regurgitation, a transesophageal echocardiogram (TEE) was performed and showed an aortic valve morphology suspicious for a quadricuspid aortic valve (Figure 1).
case_images: Mid Epigastric Short Axis View. During systole, 4 areas of commissural cusps fusion are noted (circled), suggesting aortic stenosis.
case_images: CRIC2021-5596297.002.jpg
case_images: PMC8648471_01_CRIC2021-5596297.002.jpg
case_images: fig2
case_images: The valve demonstrated doming and four areas of commissural fusion were noted (Figure 2).
case_images: Mid epigastric long axis view. In Figure 3, aortic valve doming is seen during midsystole, suggesting asymmetry and restriction. In Figure 4, taken with doppler ultrasonography during middiastole, a "mosaic pattern" (star) is evident in the left ventricular area, suggesting aortic regurgitant flow.
case_images: CRIC2021-5596297.003.jpg
case_images: PMC8648471_01_CRIC2021-5596297.003.jpg
case_images: fig3
case_images: The aortic root was mildly enlarged at 4.51 cm (Figure 3). The presence of a systolic aortic cusp doming also suggested a superimposed aortic stenosis (Figure 3).
case_images: Mid epigastric long axis view. In Figure 3, aortic valve doming is seen during midsystole, suggesting asymmetry and restriction. In Figure 4, taken with doppler ultrasonography during middiastole, a "mosaic pattern" (star) is evident in the left ventricular area, suggesting aortic regurgitant flow.
case_images: CRIC2021-5596297.004.jpg
case_images: PMC8648471_01_CRIC2021-5596297.004.jpg
case_images: fig4
case_images: There was holodiastolic flow reversal noted at the proximal descending aorta which helped to support severe regurgitation (Figures 4 and 5).
case_images: Descending aorta long axis view. In this image, a holosystolic aortic regurgitation is shown by the waveform labeled "I."
case_images: CRIC2021-5596297.005.jpg
case_images: PMC8648471_01_CRIC2021-5596297.005.jpg
case_images: fig5
case_images: There was holodiastolic flow reversal noted at the proximal descending aorta which helped to support severe regurgitation (Figures 4 and 5).