Abstract
We present a case of a 43-year-old female with a rare congenital quadricuspid aortic valve (QAV) leading to severe aortic regurgitation (AR) and acute decompensated systolic heart failure. This case highlights the diagnostic challenges associated with QAV, particularly when using transthoracic echocardiography (TTE), and emphasizes the importance of advanced imaging techniques like transesophageal echocardiography (TEE) and cardiac magnetic resonance (CMR) imaging in confirming the diagnosis. Prompt diagnosis and surgical intervention are crucial in preventing the progression of heart failure and improving outcomes.