Quadricuspid Aortic Valve with Anomalous Coronary Artery: Comprehensive Evaluation with Multidetector Computed Tomography

A 53-year-old man was admitted because of exertional dyspnea. Transthoracic echocardiography revealed aortic valve (AV) deformity. The aortic cusps were not clearly defined. Doppler examination revealed severe aortic regurgitation. It was decided to use cardiac multidetector computed tomography (MDCT) to clarify the AV configuration and to rule out coronary stenosis before operation. The MDCT images showed a quadricuspid AV with 4 equal-sized cusps, a central coaptation defect, and central aortic regurgitation (Fig. 1). The ostia of the left anterior descending coronary artery (LAD) and the right coronary artery (RCA) were juxtaposed at the right coronary sinus (Fig. 2). The proximal segment of the LAD coursed between the aortic root and the right ventricular outflow tract (Fig. 3). The left circumflex coronary artery originated from the proximal segment of the RCA (Fig. 4) and coursed posterior to the aortic root, and then into the atrioventricular groove (Fig. 5). The ascending aorta was mildly enlarged. No significant coronary stenosis was found. The MDCT findings of a quadricuspid AV and anomalous coronary arteries were all confirmed during the subsequent surgery. Fig. 1 Multidetector computed tomogram (short-axis view) of the aortic valve during diastole shows 4 equal-sized cusps and lack of coaptation of the valve leaflets, with a regurgitation orifice. Fig. 2 Multidetector computed tomogram (oblique axial view) reveals that the ostia of the left anterior descending coronary artery (arrowhead) and the right coronary artery (arrow) are juxtaposed at the right coronary sinus. Calcium is also found at the ... Fig. 3 Volume-rendered multidetector computed tomogram reveals that the left anterior descending coronary artery (LAD) originates from the right aortic sinus and courses between the aortic root and the right ventricular outflow tract. Fig. 4 Multidetector computed tomogram (oblique axial view) reveals that the left circumflex coronary artery (arrowhead) originates from the proximal segment of the right coronary artery (arrow). Fig. 5 Volume-rendered multidetector computed tomogram shows that the proximal segment of the left circumflex coronary artery (LCx) courses posterior to the aortic root and then into the atrioventricular groove. Ao = aorta; LA = left atrium; RCA = right ...