Background: Quadricuspid aortic valve (QAV) is a rare congenital heart disease with a limited body of literature. This retrospective cohort study investigates QAV morphology, function, and clinical outcomes.
Methods: Echocardiography was used to assess valvular function. Morphological characteristics such as phenotypes, raphe, regurgitant orifice area (ROA), and aortic dilation (diameter >40 mm) were assessed by cardiac CT. Patients were followed up for the combined event of all-cause death and aortic valve replacement (AVR).
Results: Ninety QAV patients (screened from 322385 CT scans) were included (mean age 55.2 ± 13.6 years, 61.1 % male). Isolated significant aortic regurgitation (AR) was present in 75.6 % of patients. The cohort was dominated by type I (four equal leaflets, 37.8 %) and type II (3 larger and 1 smaller leaflets, 42.2 %) QAV. Fused raphe was present in 26.7 % of patients. ROACT was correlated with AR severity and aortic dilation (41.1 %, n = 37). Among patients without AVR at baseline (n = 60), one died and 17 underwent AVR during a median follow-up of 35.0 months (IQR:17.3-62.8). ROACT was associated with an increasing risk of combined event (as a categorical variable with a cut-off of 21.4 mm2, HR = 4.25, 95%CI 1.49-12.17, p = 0.007; as a continuous variable (per mm2 increment), HR = 1.04, 95%CI 1.01-1.07, p = 0.003). Additionally, ROACT had incremental prognostic value when added to the AR severity model (area under the receiver-operating characteristic curve increased from 86.8 to 88.4, p = 0.004).
Conclusion: QAV is characterized by variable anatomy, progressive AR, concomitant cusp fusion and aortic enlargement. ROACT may be a potential ancillary prognostic marker in patients with QAV.
Keywords: Aortic dilation; Aortic regurgitation; Multimodality imaging assessment; Quadricuspid aortic valve.
Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.