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Ann Thorac Surg 2007;83:1581
© 2007 The Society of Thoracic Surgeons

Correspondence

Surgical Pitfalls of the Quadricuspid Aortic Valve

Oktay Tutarel, MD, Philipp Roentgen, MD, Mechthild Westhoff-Bleck, MD

Department of Cardiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany

(Email: otutarel{at}hotmail.com).

To the Editor:

We read with interest the case series by Pirundini and colleagues [1], reporting their surgical experience with quadricuspid aortic valves (QAV).

The authors state that the most common anatomic variant of QAV is consisting of three equal cusps and one smaller cusp. However, according to the most comprehensive review of this topic available to date, the most common type of QAV is the type with four equal cusps [2]. While this is probably only of academic interest, dysfunction of the valve can be found in approximately 80%–90% of cases in both types, there is one pitfall facing the surgeon operating on a case with a quadricuspid aortic valve not mentioned by the authors: QAVs are often associated with other congenital heart defects [2]. In approximately 18% of the cases reviewed, an additional malformation was found. As was previously mentioned by us [3], it is of special importance to the surgeon that anomalies of the coronary arteries are the most frequent cardiac defects associated with a QAV. They can be found in approximately 10% of the cases [2, 3]. Single coronary ostium [4] and displacement of the coronary orifices [5, 6] have all been reported in association with a QAV. Aoyagi and colleagues [7] remarked that from the surgical standpoint it is important to recognize any displacement of the coronary ostia to prevent ostial obstruction of the coronary arteries during fixation of the prosthetic valve ring. Therefore, a careful evaluation of the cardiac anatomy in cases with a QAV prior to surgery is of utmost importance [3].


   References
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 References
 

  1. Pirundini PA, Balaguer JM, Lilly KJ, et al. Replacement of the quadricuspid aortic valve: strategy to avoid complete heart block Ann Thorac Surg 2006;81:2306-2308.[Abstract/Free Full Text]
  2. Tutarel O. The quadricuspid aortic valve: a comprehensive review J Heart Valve Dis 2004;13:534-537.[Medline]
  3. Tutarel O. Quadricuspid aortic valves and anomalies of the coronary arteries J Thorac Cardiovasc Surg 2004;127:897.[Free Full Text]
  4. Kim HS, McBride RA, Titus JL. Quadricuspid aortic valve and single coronary ostium Arch Pathol Lab Med 1988;112:842-844.[Medline]
  5. Wyatt JP, Goldenberg H. Supernumerary aortic cusps with multiple fenestrations and with displacement of the left coronary orifice Arch Pathol 1948;45:784-786.
  6. Lanzillo G, Breccia PA, Intonti F. Congenital quadricuspid aortic valve with displacement of the right coronary orifice Scand J Thorac Cardiovasc Surg 1981;15:149-151.[Medline]
  7. Aoyagi S, Kawara T, Yasunaga H, Kosuga K, Oishi K. Congenital quadricuspid aortic valve associated with aortic regurgitation Thorac Cardiovasc Surg 1992;40:225-226.[Medline]

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Paul A. Pirundini, Kevin J. Lilly, and Robert J. Rizzo
Ann. Thorac. Surg. 2007 83: 1581. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., April 1, 2007; 83(4): 1581 - 1581.
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