Unusual Cause of Pulmonary Regurgitation: Quadricuspid Pulmonary Valve Detected by Cardiac MRI

Presenting Author(s)

• 

  Pablo Maximiliano Pollono, MD

  Staff Cardiologist – Cardiac Imaging (CT)
  CIMED
  La Plata, Buenos Aires, Argentina

Primary Author(s)

• 

  Javier Kobylanski

  Staff Cardiologist – Cardiac Imaging (CT & MRI)
  HIGA Gral. San Martín de La Plata/CIMED
  La Plata, Buenos Aires, Argentina

Co-Author(s)

• GP

  Gaston Oscar Pantoja

  Staff Cardiologist – Cardiac Imaging (CT & MRI)
  CIMED
  La Plata, Buenos Aires, Argentina
• 

  Juan Diego Wolcan, MD

  Staff Cardiologist – Cardiac Imaging (CT)
  CIMED
  La Plata, Buenos Aires, Argentina
• JC

  Juan Ignacio Cerezo

  Specialist in Diagnostic Imaging
  CIMED
  Villa Elisa, Buenos Aires, Argentina
• LO

  Lucía Marianela Ortiz

  Staff Cardiologist – Congenital Heart Disease
  Hospital Español de La Plata, Buenos Aires, Argentina

Description of Clinical Presentation: A 25-year-old patient with a history of pulmonary regurgitation diagnosed in childhood, with no determined etiology.

Diagnostic Techniques and Their Most Important Findings: Cine sequences demonstrated preserved right and left ventricular size and function. In the right ventricular outflow tract view, pulmonary regurgitation was identified, with prolapse of one cusp toward the ventricular side, along with apparent dilatation of the main pulmonary artery. A dedicated perpendicular view of the pulmonary valve was performed to better assess its anatomy, revealing a quadricuspid valve with three normal-sized cusps and a smaller, posterior fourth cusp.

Angiography showed a dilated main pulmonary artery measuring 39.4 × 32 mm, a left pulmonary artery measuring 21.6 × 17.8 mm, and a right pulmonary artery measuring 23.5 × 14.8 mm.

Phase-contrast sequences demonstrated moderate pulmonary regurgitation, with a regurgitant fraction of 21% and peak flow velocity of 1.48 m/s.

Learning Points from this Case: Cardiac magnetic resonance provides valuable answers in such clinical scenarios. A high index of suspicion, together with optimal use of the scanner’s capabilities, is required to accurately assess patient anatomy.

An axial view of the right ventricular outflow tract showing pulmonary regurgitation due to valvular prolapse.
A perpendicular view of the pulmonary valve showing four leaflets.
Flow sequence and quantification showing mild-to-moderate regurgitation fraction.