Novel coronary ostia-oriented classification for quadricuspid aortic valve: insights from a case report and literature review.

BACKGROUND

Quadricuspid aortic valve (QAV) is a rare congenital anomaly. While existing classifications (Hurwitz, Nakamura) describe cusp morphology, they fail to address coronary ostial involvement, a major determinant of surgical risk.

METHODS

We present a 38 year-old woman with severe aortic insufficiency (AI) due to Type 3 QAV (Nakamura classification) who underwent aortic valve replacement. Preoperative echocardiography confirmed four equal cusps. Based on this case and literature review, we developed the University of Illinois at Chicago (UIC) classification system for QAV, focused on the spatial relationship between cusps and coronary ostia.

RESULTS

The UIC classification defines four classes: Class 1 (non-ostial involvement, repair feasible), Class 2 (ostial-proximate, complex repair or replacement with coronary protection), Class 3 (ostial-obstructing, replacement with possible reimplantation or CABG), and Class 4 (fenestrated/redundant, risk of dynamic obstruction or embolization). The patient's postoperative course was uneventful, with preserved ventricular function at 8 months.

CONCLUSIONS

The UIC classification incorporates coronary ostial assessment into QAV management, complementing existing morphological systems and guiding surgical planning. Prospective validation in larger cohorts is warranted.