Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 16, Number 8, August 2025, pages 277-281

Thinking Outside the Box: Case Report of a Rare Quadricuspid Aortic Valve as an Underrecognized Cause of Heart Failure and Atrial Fibrillation

Figures

Figure 1.
Figure 1. Transesophageal echocardiography views of the aortic valve. (a) Mid-esophageal short-axis view at 54°, demonstrating a quadricuspid aortic valve (Hurwitz and Roberts type C) with four distinct cusps. The individual cusps are labeled to aid visualization. (b) Mid-esophageal long-axis view at 130° with color Doppler, showing central aortic regurgitation jet consistent with moderate aortic insufficiency.
Figure 2.
Figure 2. Cardiac magnetic resonance imaging in short-axis view demonstrating quadricuspid aortic valve morphology. (a) Diastolic phase: incomplete cusp coaptation with central aortic regurgitation orifice, consistent with moderate aortic regurgitation. (b) Systolic phase: the aortic valve leaflets are fully open, visualizing four distinct cusps.