K. Yin1,2, Z. Zhang1, L. Dong3, Y. Lin1, C. Wang1 3Zhongshan Hospital Of Fudan University,Department Of Echocardiography,Shanghai, SHANGHAI, China 1Zhongshan Hospital Of Fudan University,Department Of Cardiac Surgery,Shanghai, SHANGHAI, China 2Harvard Chan School Of Public Health,Boston, MA, USA
Introduction: Quadricuspid aortic valve (QAV) is a rare and poorly understood congenital cardiac anomaly. Controversy remains over its association with aortic dilation, and limited evidence is available regarding the surgical outcomes. This study aims to evaluate the clinical features of QAV and examine the surgical outcomes.
Methods: From January 2011 to December 2016, 35 consecutive QAV patients (mean age, 50.4 ± 11.9 years; male, 54.3%) were identified by echocardiography and confirmed during surgery (frequency, 0.0057%). All patients had significant aortic insufficiency with severe regurgitation in 21 patients (60%). The mean left ventricular end-diastolic dimension was 5.9 ± 0.7 cm, and the mean ejection fraction was 62% ± 7%. Eight patients (22.9%) had aortic stenosis with mild in 7 and moderate in 1. Ascending aortic diameter was ≥ 4 cm in 7 patients (20%) with mean diameter 4.2 ± 0.2 cm. Three patients (8.6%) had endocarditis preoperatively.
Results: All patients received aortic valve replacement with the median valve size 23 mm (range: 19 to 25 mm). Two patients (5.7%) required ascending aorta replacement, and the other concomitant procedures included mitral repair/replacement in 3 (8.6%) and tricuspid repair in 1 (2.9%). There was no early or late death. The median postoperative ICU and hospital stays were 2 and 7 days, respectively. No myocardial infraction, respiratory failure, renal failure or reoperation for bleeding, occurred postoperatively. Mean follow-up time was 25.1 ± 18.0 months and was complete for 94.3% of patients. One patient developed perivalvular leakage and subvalvular abscess two years after the initial aortic valve replacement and received a reoperative Bentall procedure.
Conclusion: Aortic insufficiency is the predominant hemodynamic abnormally in QAV patients. Compared with those in bicuspid aortic valves, the incidence and extent of aortic dilation seem to be uncommon and less severe in QAV. The short- and mid-term outcomes are satisfactory.
