Aortic valve replacement for quadricuspid valve: a lesson learnt from a negative experience.

Quadricuspid aortic valve is a rare congenital abnormality often associated with valve incompetence and requires surgical correction in adulthood. However, using a standard suture technique of aortic valve replacement, postoperative complete atrioventricular block is not uncommon because of the downward displacement of the supranumerary leaflet towards the membranous septum. We describe a suture technique where the sutures on the supranumerary leaflet were passed through the aortic sinusal wall above the valvar hinge. This technique can preclude injury to the conduction system, thereby avoiding atrioventricular block.