CONTENT

Case 1: A 50-year-old female patient presented with recurrent syncope and reduced exercise tolerance. Transthoracic echocardiogram (TTE) showed severe pulmonary regurgitation (PR) (Figure 1A). Computed tomography (CT) revealed a quadricuspid pulmonary valve (QPV) with 4 equal cusps (Figure 1B). Transcatheter pulmonary valve implantation (TPVI) was chosen as the most suitable option based on the patient's clinical condition. A P36-25 mm self-expandable Venus P-valve (Venus Medtech, Hangzhou, China) was implanted (Video 1). Post-implantation angiography showed no perivalvular leakage and proper valve positioning and function (Figure 1C). At 2-year follow-up, the patient had no recurrence of syncope, and TTE showed satisfactory valve function with no perivalvular leakage (Figure 1D).

Case 2: A 35-year-old woman was admitted for TPVI. She underwent surgical repair for severe pulmonary stenosis and atrial septal defect 5 years ago, with an uneventful recovery. Transthoracic echocardiogram revealed severe PR (Figure 1E). Computed tomography imaging showed QPV with 1 rudimentary cusp (Figure 1F). the patient underwent a successful TPVI with a P32-30 mm self-expandable Venus P-valve (Figure 1G, Video 2). At the 10-year follow-up, the patient remained stable, and her TTE showed a persistently good valve function and no perivalvular leakag (Figure 1H).

Quadricuspid pulmonary valve is a rare congenital malformation that can be associated with significant valvular dysfunction and thus often requires early intervention.¹ While surgery has been the mainstay of treatment, TPVI has emerged as a promising alternative in selected cases with suitable anatomy.

These cases demonstrate the feasibility of TPVI in quadricuspid anatomy with excellent long-term efficacy. To the authors’ knowledge, these are the first 2 cases reporting TPVI in QPV. Larger studies with long-term follow-up are warranted to confirm the safety and efficacy of TPVI in QPV.

Footnotes

Informed Consent: This study was approved by the Institutional Review Board, and written informed consent was obtained from the patients.

Artificial Intelligence (AI) Statement: This manuscript was prepared without the use of AI technologies, including Large Language Models (LLMs), chatbots, image creation tools, or any other AI-based tools.

Declaration of Interests : The authors have no conflicts of interest to declare.

Videos 1, 2: The final pulmonary angiogram reveals the valve implanted in the pulmonary trunk, with no residual pulmonary regurgitation detected.

Reference

1. Miyake T, Inoue T, Mushiake S. Quadricuspid pulmonary valve: case report and the comparison with quadricuspid aortic valve. Curr Cardiol Rev. 2023;19(2):e220322202505-. https://doi.org/10.2174/1573403X18666220322092706