42 y M I did his echo and the finding was
Quadricuspid aortic valve (QAV)
is a congenital heart anomaly in which the aortic valve has four cusps of various size possibilities, as opposed to the three symmetrical cusps generally observed.
This cardiac valvular abnormality is rarely identified, with an estimated incidence rate of 0.013% to 0.043%,
although recent technological advancements in diagnostics have contributed to an increase in detection. Historically, it had been typically encountered during open heart surgery or postmortem; however, it is presently diagnosed primarily via ultrasound echocardiography, and could go undetected unless specifically considered
This condition is sporadically associated with additional congenital cardiovascular defects, with coronary artery irregularities being the most common.
This imaging maybe worthy of submitting to a cardiology journal or image challenge for NEJM.