Abstract A 39-year-old male patient from a county health facility presented to our department with a one-year history of progressive exertional chest tightness (NYHA class III-IV), which resolved completely within five to six minutes of rest. Both motion and static imaging results revealed a rare solitary Quadricuspid aortic valve (QAV) with severe aortic valve regurgitation. The QAV was replaced with mechanical prosthetic valve via mini-superior sternotomy on cardiopulmonary bypass machine. The patient was reviewed a month after operation, and assessment revealed that he had reverted to NYHA class-I. A rare congenital lesion such as QAV, repair may not be the best option due to lack of long-term data on longevity. Additionally, choice of a mechanical prosthetic valve guarantees unwanted re-operations associated with possible failure of bioprosthetic valves.
