Quadricuspid Pulmonary Valve in a neonate with Wolff-Parkinson-White syndrome

DOI: https://doi.org/10.21203/rs.3.rs-172115/v1

Abstract

Quadricuspid pulmonary valve is a rare abnormality which has been reported in isolation or with structural ehart diseases. We report a neonate who presented with supra-ventricular tachycardia and Wolff-Parkinson-White syndrome who had a structurally normal heart. The recognition of a phasic ejection click on clinical examination led to the identification of a normally functioning quadricuspid pulmonary valve

Main Text

A 7-day old baby was referred with poor feeding, irritability and tachycardia. On admission, he had a regular narrow complex tachycardia which terminated with Adenosine. A screening echocardiogram at admission suggested a structurally normal heart with depressed contractility on subjective assessment. An electrocardiogram performed after termination showed a narrow P-R interval, broad QRS and a delta wave typical of Wolff-Parkinson-White Syndrome (Fig 1). On auscultation, the first heart sound was normal, and the second heart sound was normally split. A phasic systolic ejection click was heard with no murmurs.

The baby was hence subjected to a detailed echocardiogram which showed a quadricuspid pulmonary valve (Fig 2A and B, Video 1 and 2). This was best imaged in the modified para-sternal short axis view. There was no evidence of pulmonary stenosis or regurgitation. The leaflets were of equal size and corresponded to Type A of the classification proposed by Hurwitz and Roberts (1). Quadricuspid pulmonary valve has been reported in association with structural heart diseases but an association with WPW syndrome has not been reported to the best of our knowledge (2).

Declarations

Compliance with Ethical Standards: 

Funding: No funding was involved in this report. 

Conflict of Interest: The author declares that he had no conflict of interest to declare with regards to this report

Informed consent: Informed consent was obtained from the parents of the neonate who was involved in the study 

References

  1. Hurwitz LE, Roberts WC (1973) Quadricuspid semilunar valve. Am J Cardiol 31(5):623–626
  2. Davia JE, Fenoglio JJ, DeCastro CM, McAllister HA Jr (1977) Cheitlin MD. Quadricuspid semilunar valves. Chest 72:186–189