Excerpt

A 56-year-old man presented to the outpatient department with a history of atypical chest pain. He had no traditional risk factors. Cardiac auscultation revealed a 3/6 early diastolic murmur along the lower left sternal border. Electrocardiography was normal. Transthoracic echocardiography showed normal left-ventricular dimension with normal left-ventricular ejection fraction (55%). Transthoracic and transesophageal echocardiography showed unusual quadricuspid aortic valve with four equal size cusps (Fig. 1a, b, Video 1 in Supplementary material).Color Doppler examination showed mild central aortic regurgitation (Fig. 2a, b; Video 2 in Supplementary material). TEE in basal short-axis view clearly demonstrated anatomy of aortic valve. Three-dimensional TEE showed excellent visualization of aortic valve anatomy (Fig. 3a, b; Video 3 in Supplementary material).

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