case_images: PMC11195687_01
case_images: (A) Transthoracic echocardiography/parasternal long-axis view showing a suspicion of a papillary fibroelastoma attached to the AV. (B) Transthoracic echocardiography/parasternal long-axis with X-plane two-dimensional (2D) display view raising a suspicion of a papillary fibroelastoma attached to the AV. Note: unclear systolic AV morphology by 2D/colour flow mapping (CFM) Doppler assessment. Suspicion of quadricuspid AV in diastole. (C) Cardiac MRI anatomical images confirming the anatomy of the quadricuspid AV. (D) Cardiac non-contrast MRI aortogram showing normal size of the ascending aorta. (E) TOE X-plane 2D display: AV mid-oesophageal long-axis view showing a quadricuspid AV:systole. (F) TOE X-plane 2D display: AV mid-oesophageal long-axis view showing a quadricuspid AV:diastole, type A with no obvious evidence of papillary fibroelastoma. (G) TOE AV 3D zoom, showing AV quadricuspid morphology type A in diastole. (H) TOE AV mid-oesophageal long-axis view in colour compare mode showing mild AV regurgitation. (I) Transthoracic echocardiography/live 3D parasternal long-axis view showing a suspicion of a papillary fibroelastoma attached to the AV. (J) Transthoracic echocardiography/parasternal long-axis: 2D display view showing left ventricle outflow tract diameter:19 mm. (K) Transthoracic echocardiography/parasternal long-axis: 2D display view showing aortic root and proximal ascending aorta dimensions (sinuses of Valsalva 28 mm, ST junction 24 mm, proximal ascending aorta 25 mm, and distal aorta 23 mm). (L) Transthoracic echocardiography/suprasternal view: 2D display with colour Doppler compare showing aortic arch and proximal descending aorta dimensions with laminar flow present/no signs of aortic coarctation. Aortic arch diameter, 21 mm; proximal descending aorta diameter, 14 mm. (M) Transthoracic echocardiography/apical five-chamber view 2D display with continuous wave Doppler interrogation, showing normal transvalvular AV flow velocity. AV max velocity -1.2 m/s. (N) Transthoracic echocardiography/apical five-chamber view 2D display with continuous wave Doppler interrogation, showing no significant aortic regurgitation/suboptimal aortic regurgitation Doppler alignment. Transthoracic Echocardiography US Epiq CVx, Transducer X5-1 Transoesophageal Echocardiography US Epiq CVx, and Transducer X8-2t.
case_images: qyae025f1.jpg
case_images: PMC11195687_01_qyae025f1.jpg
case_images: qyae025-F1
case_images: It also raised suspicion of a mass attached to the cusps of the AV on the aortic side (Figure 1A and B) and suspected papillary fibroelastoma. The 3D TOE and CMR images clearly visualized the AV, showing a round opening. The valve was found to have four equal cusps, classifying it as a type A quadricuspid AV according to the Hurwitz and Roberts classification (Figure 1C-G). Further imaging with CMR non-contrast aortogram confirmed no evidence of associated aortopathy (Figure 1D, H).