Author(s): Seol SH, Kim U, Cho HJ, Kim DK, Kim DI
A 30-year-old woman was referred to our hospital for evaluation of increasing dyspnea on exertion. On physical examination, a continuous Gibson murmur was heard at the upper left sternal border. Results of electrocardiography and chest radiography were normal. Transthoracic echocardiography revealed a quadricuspid aortic valve with mild aortic regurgitation; color-flow Doppler imaging showed a narrow mosaic jet; and continuous-wave Doppler imaging showed high-velocity left-to-right flow. There was no atrial or ventricular dilation, and systolic function was normal. Aortography showed shunting from the aorta into the pulmonary artery (Fig. 1). Transesophageal echocardiography showed the X-shaped commissural pattern of a quadricuspid aortic valve (Fig. 2A) and a patent foramen ovale (Fig. 2B). A patent ductus arteriosus (PDA) was closed percutaneously with use of an AMPLATZER® duct occluder (AGA Medical Corporation; Plymouth, Minn).