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A Five-Leaf Clover or an Exceptionally Rare Cause of Severe Aortic Insufficiency?

      A 56-YEAR-old, 68- kg, 165- cm woman with a history of Crohn's disease presented to the authors’ institution with dyspnea and exercise intolerance of several months’ duration. More recently, her symptoms had progressed to occasional dyspnea at rest. She denied fever, chills, chest pain or pressure, palpitations, orthopnea, paroxysmal nocturnal dyspnea, syncope, and peripheral swelling. The physical examination was notable for a grade III of VI holodiastolic murmur. The electrocardiogram and laboratory analysis were noncontributory. Transesophageal echocardiography (TEE) was performed as part of the diagnostic evaluation and the following images were obtained (Fig. 1-4; Videos 1-4). What is the diagnosis?
      Fig 1
      Fig 1A midesophageal aortic valve short-axis transesophageal echocardiography view.

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      References

        • Simonds JP.
        Congenital malformation of the aortic and pulmonary valves.
        Am J Med Sci. 1923; 166: 584-595
        • Cemri M
        • Cengel A
        • Timurkaynak T.
        Pentacuspid aortic valve diagnosed by transesophageal echocardiography.
        Heart. 2000; 84: E9
        • Kamata S
        • Sakagoshi N
        • Ohata T
        • et al.
        Successful surgical treatment of pentacuspid aortic valve with severe aortic regurgitation.
        Jpn J Cardiovasc Surg. 2008; 37: 53-55
        • Wang S
        • Meng X
        • Zhang H
        • et al.
        Pentacuspid aortic valve with severe aortic regurgitation.
        Ann Thorac Surg. 2010; 89: 2034-2036
        • Tutarel O.
        The pentacuspid aortic valve.
        Ann Thorac Surg. 2011; 91: 646
        • Kuroki H
        • Hirooka K
        • Ohnuki M.
        Pentacuspid aortic valve causing severe aortic regurgitation.
        J Thorac Cardiovasc Surg. 2012; 143: e11-e12
        • Ozyilmaz S
        • Akgul O
        • Guzeltas A
        • et al.
        Diagnosis of pentacuspid aortic valve with severe regurgitation using three-dimensional transesophageal echocardiography.
        Echocardiography. 2015; 32: 393-394
        • Al Ansari AE
        • Adbdulrahman A
        • Shaikho NMG
        • et al.
        A very rare cause of aortic regurgitation: Pentacuspid aortic valve.
        Eur Heart J Case Rep. 2021; 5: ytab038
      1. Motoki T, Ikeno Y, Suehiro Y, et al. A successful repair of pentacuspid aortic valve [e-pub ahead of print]. JTCVS Tech 2022;14:69--72

        • Janssens U
        • Klues HG
        • Hanrath P.
        Congenital quadricuspid aortic valve anomaly associated with hypertrophic non-obstructive cardiomyopathy: A case report and review of the literature.
        Heart. 1997; 78: 83-87
        • Davia JE
        • Fenoglio JJ
        • DeCastro CM
        • et al.
        Quadricuspid semilunar valves.
        Chest. 1977; 72: 186-189
        • Gordon S
        • Butler M.
        Quadricuspid aortic valve.
        Am J Cardiol. 1991; 67: 323-324
        • Feldman BJ
        • Khandheria BK
        • Warnes CA
        • et al.
        Incidence, description and functional assessment of isolated quadricuspid aortic valves.
        Am J Cardiol. 1990; 65: 937-938
        • Serna-Gallegos D
        • Sultan I.
        Commentary: Aortic valve repair: How much is too much?.
        J Thorac Cardiovasc Surg Tech. 2022; 14: 73-74