Quadricuspid Aortic Valve by Transesophageal Echocardiography

Quadricuspid aortic valves (QAVs) are a rare congenital anomaly associated with increased risk of aortic insufficiency. This case presents the incidental finding of a QAV on intraoperative transesophageal echocardiography (TEE) after going undetected on transthoracic echocardiography multiple times, suggesting that TEE may be a superior imaging modality for the identification of this defect. This patient with a history of coronary artery disease presented with sudden onset moderate to severe aortic insufficiency and required subsequent aortic valve replacement (AVR).