Abstract
BACKGROUND: Quadricuspid aortic valve (QAV) is a rare congenital anomaly with an incidence of 0.006% to 0.05%. It often leads to aortic stenosis or regurgitation due to progressive fibrosis and calcification. While surgical aortic valve replacement has been the standard treatment, transcatheter aortic valve implantation (TAVI) is emerging as a less invasive alternative for high-risk patients. CASE SUMMARY: An 84-year-old woman with ischemic cardiomyopathy and heart failure presented with severe aortic stenosis on a calcified QAV. Given her high surgical risk (EuroSCORE II: 9.69), she underwent successful transfemoral TAVI with a 23-mm Edwards Sapien III Ultra valve. Postoperatively, she developed a left bundle branch block requiring an upgrade to cardiac resynchronization therapy with defibrillator. At the 1-year follow-up, she remained minimally symptomatic with excellent valve function. TAKE-HOME MESSAGE: TAVI is a feasible and effective option for treating severe aortic stenosis in patients with QAV, offering a viable alternative to surgery in high-risk cases.