Fig. 1

a. Transthoracic echocardiography showing a quadricuspid aortic valve with an ‘X-shaped’ commissural contour in the diastole. b. Computed tomographic angiography showing an aortic valve consisting of four symmetrically-sized cusps and a central coaptation defect resulting in central aortic regurgitation. c. Three-dimensional reconstruction imaging of computed tomography showing aneurysmal ascending aortic dilatation (maximum diameter = 45 mm) with preservation of the normal dimensions of the aortic root. d. and e. Volume-rendered multidetector computed tomography showing the spatial and anatomical relationships of the aortic cusps and the oval-shaped, single united coronary ostium