Transcatheter aortic valve replacement in patients with quadricuspid aortic valve in a single center

Figures

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  FIGURE 1. Anatomical structures of the quadricuspid aortic valves of five patients demonstrated with computed tomography angiography (CTA), 3-dimensional (3D) simulation, and 3D printing models.

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  FIGURE 2. Procedural details of transcatheter aortic valve replacement (TAVR) with the self-expandable J-Valve prosthesis in a patient with a quadricuspid aortic valve with pure aortic regurgitation. (A) 2-Dimensional transesophageal echocardiography (TEE) with color Doppler showed aortic regurgitation in the quadricuspid aortic valve before the procedure. (B) Preoperative angiography showed four sinuses and aortic regurgitation. (C) Postoperative angiography showed the final position of a 29 mm J-Valve prosthesis without a paravalvular leak after deployment. (D) 2-dimensional TEE with color Doppler showed no aortic regurgitation postprocedure.

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  FIGURE 3. Procedural details of transcatheter aortic valve replacement (TAVR) with the self-expandable Venus-A prosthesis in a patient with quadricuspid aortic valve with aortic stenosis (AS) and regurgitation. (A) 2-Dimensional transesophageal echocardiography (TEE) with color Doppler showed aortic regurgitation in the quadricuspid aortic valve before the procedure. (B) Angiography showed a satisfactory position of the THV prosthesis before deployment. (C) Angiography showed the final position of a 32 mm Venus-A prosthesis without a paravalvular leak after deployment. (D) 2-Dimensional TEE with color Doppler showed no aortic regurgitation postprocedure.

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  FIGURE 4. Hurwitz and Roberts classification of the quadricuspid aortic valve (QAV). (A) QAV with four equal-sized cusps. (B) QAV with three equal-sized cusps and one smaller cusp. (C) QAV with two equal larger cusps and two equal smaller cusps. (D) QAV with one larger cusp, two mid-sized cusps, and one smaller cusp. (E) QAV with one larger cusp and three equal-sized smaller cusps. (F) QAV with two equal-sized large cusps and two unequal smaller cusps. (G) QAV with four unequal-sized cusps.