LAUSR

Quadricuspid aortic valves (QAV) are associated with an increased incidence of aortic insufficiency (AI) and coronary artery anomalies. We present images of a patient withQAV andAIwith two separate left coronary ostia. A 50-year-old female with a known QAV and AI was referred for aortic valve replacement due to progressive left ventricular (LV) enlargement and declining LV function on serial transthoracic echocardiograms (Figure 1). A computed tomography coronary angio revealed two separate left coronary ostia supplying the left anterior descending and left circumflex coronary arteries (Figures 2 and 3). At the time of surgery, these anomalies were confirmed (Figures 4-6) and the aortic valve was replaced with a #21 St. Jude Regent mechanical valve (Abbott Inc., Abbott Park, IL). The patient tolerated the procedure well and had an uncomplicated postoperative course. DECLARATIONS