A case of quadricuspid aortic valve is reported. The anomaly was unexpectedly found during surgery for aortic valve replacement in a 33-year-old man with aortic insufficiency. The supernumerary cusp was positioned between the right and the left coronary cusps. These three cusps were fairly uniform, although the non-coronary cusp was smaller. The cusps were excised and replaced with a Björk-Shiley valve. Congenital quadricuspid aortic valve is a rare abnormality, and only 39 cases have been reported. Most patients developed aortic insufficiency after reaching adulthood and nine patients had aortography or echocardiography. We propose to group congenital quadricuspid aortic valve into two types. Type 1: the supernumerary cusp is located anteriorly, that is, between the right and the left coronary cusps. The present case belongs to this type. Type 2: the supernumerary cusp is posterior and is situated between the right and the non-coronary cusps. In this type, the supernumerary cusp is always smaller than the other cusps.

We describe two cases of aortic regurgitation with dove-coo murmur that required aortic valve replacements. In the first case, there were three small perforations of the cusps, two in the noncoronary cusp and one in the right coronary cusp. The cause of the cusp perforations was unclear. In the second case, there were two perforations of the cusps, one in the left coronary cusp and another small one in the right coronary cusp, along with a subannular pseudoaneurysm. The cause of the cusp perforations was an infective endocarditis. Before 1955, aortic regurgitations with dove-coo murmur were mostly reported to be originated by retroversion of the valve cusps due to syphilis. After 1960, syphilis was replaced by various diseases that bring about perforations, tears and retroversions of the cusps. The condition which is concerned in the development of the dove-coo murmur is that the aortic valve cusps have lesions without calcification and preserve the flexibility.

A 60-year-old male was transferred to a critical care medical center with a complaint of sudden back pain. He already had suffered severe back pain 22 years previously when he was 38-year-old), but was not diagnosed then. On admission thoracic CT scan revealed a three-channeled structure in the descending aorta. The preoperative diagnosis was an acute redissection of a DeBakey III b dissecting aortic aneurysm. An emergency graft replacement of the descending aorta confirmed the three-channeled structure of the aorta. The remaining of media of the aorta, which occurred in the re-dissected lumen, was thin and weak. The patient was alive and well twenty-five months following the operation.