ABSTRACT
Quadricuspid aortic valve is a rare congenital heart defect. Several different anatomical variations of a quadricuspid aortic valve have been described and aortic regurgitation is the predominant valvular dysfunction associated with it. A 57-year-old hypertensive gentleman presented with a four months history of worsening dyspnea on exertion. The patient had a previous transthoracic echocardiography done one month ago that demonstrated mild to moderate aortic regurgitation. Transoesophageal echocardiography displayed a rare case of quadricuspid aortic valve with four cusps of equal size. The malformation was associated with moderate aortic regurgitation. The use of transoesophageal echocardiography is often warranted to diagnose quadricuspid aortic valve if optimal display of the valvular morphology is desired