case_images: PMC11749646_01
case_images: (A) A QAV in the short-axis view of the aortic root, (B) Aortic annular diameter was measured to be approximately 22 mm, (C) Cardiac-enhanced CT showed an anomalous aortic origin of the left coronary artery from the right coronary sinus with an intramural course, (D) The presence of QAV and double coronary artery ostia in the right sinus of Valsalva, (E) Pulmonary artery wall affixed below the coronary artery, (F) smooth LVOT, (G) and (H) Confluent ostium of coronary arteries and normal course of the coronary arteries. CT = computed tomography, LVOT = left ventricle outflow track, QAV = quadricuspid aortic valve.
case_images: medi-104-e41302-g001.jpg
case_images: PMC11749646_01_medi-104-e41302-g001.jpg
case_images: F1
case_images: Figure 1A showed a QAV in the short-axis view of the aortic root, while severe aortic stenosis (AS) and severe aortic regurgitation (AR) were revealed in the long-axis view of the left ventricle outflow track (LVOT). The aortic annular diameter was measured to be approximately 22 mm by transesophageal echocardiography in Figure 1B. Cardiac-enhanced CT showed an anomalous aortic origin of the left coronary artery from the right coronary sinus with an intramural course (Fig. 1C). Once the routine cardiopulmonary bypass was established, a transverse aortic incision was made superior to coronary arteries, which revealed the presence of QAV and double coronary artery ostia in the right sinus of Valsalva (Fig. 1D). The autologous pulmonary valve was connected to the distal LVOT at the aortic valve annular, while the pulmonary artery wall was affixed below the coronary artery (Fig. 1E). During the intraoperative transesophageal echocardiography, it was observed that the LVOT was smooth and there was no aortic regurgitation (Fig. 1F). After the surgery, a postoperative 3D-CT revealed a confluent ostium of coronary arteries and normal course of the coronary arteries (Fig. 1G, H).