Quadricuspid aortic valve and right ventricular type of myocardial bridging in an asymptomatic middle-aged woman: A case report

Figure 1 Transthoracic echocardiographic images of the quadricuspid aortic valve. A: Parasternal short axis view of the aortic valve; B: Apical view of the aortic valve and moderate aortic regurgitation; C: Short axis view of the aortic valve and moderate aortic regurgitation.

Figure 2 Multislice computed tomography image of the quadricuspid aortic valve. A: Quadricuspid aortic valve depicted by multiplanar reformatted computed tomography (CT) image during diastole. The supranumerary cusp (asterisk) is located between the right and left coronary cusp. Central malcoaptation of the cusps can also be seen; B: Curved planar reformation of coronary CT angiography shows the right-ventricular type of myocardial bridging at the distal segment of the left anterior descending artery (marked by arrow). R: Right coronary cusp; L: Left coronary cusp; N: Noncoronary cusp; *: Supernumerary cusp; LAD: Left anterior descending.

Figure 3 Classification of quadricuspid aortic valve. A: Hurwitz and Roberts[10] (a: Four equal-sized cusps; b: Three equal-sized larger cusps and one smaller cusp; c: Two equal-sized larger cusps and two equal-sized smaller cusps; d: One larger cusp, two equal mid-sized cusps and one smaller cusp; e: Three equal-sized smaller cusps and one larger cusp; f: Two equal-sized larger cusps and two unequal smaller cusps; g: Four unequal cusps); B: Vali et al[11] supplement to Hurwitz and Roberts quadricuspid aortic valve classification (Type h: One larger cusp, one mid-sized cusps and two equal-sized smaller cusp); C: Nakamura et al[12] (Type I: Supernumerary cusp between the left and right coronary cusps; Type II: Supernumerary cusp between the right and non-coronary cusps; Type III: Supernumerary cusp between the left and noncoronary cusps; Type IV: Unidentified supernumerary cusp as of two equal-sized smaller cusps; L: Left coronary cusp; N: Noncoronary cusp; R: Right coronary cusp; S: Supernumerary cusp).