The left AV valve was competent, and there was normal ventriculoarterial concordance, with no abnormality of the
semilunar valves or great arteries.
A study of autopsy specimens of normal hearts concluded that, in both genders, all indexed mean valve circumferences progressively increased throughout adult life, and this trend was greater for the
semilunar valves than the atrioventricular valves.[sup][10] Additionally, aortic root dilatation is one of most common causes of AR.[sup][11] A study assessing clinical determinants of valvular regurgitation from the Framingham Heart Study revealed that the clinical determinants of MR were age, hypertension, and BMI.
QAV is a rare abnormal development of
semilunar valves that has been reported in 0.008%, 0.043%, and 1% in, respectively, autopsy series, two-dimensional TTE, and in aortic valve surgery [6].
The standard operative technique involves removal of both donor and recipient hearts at the midatrial level, preserving the multiple pulmonary venous connections to the recipient's left atrium with the great vessels resected just above the
semilunar valves. This process is quicker but can cause some degree of atrial and tricuspid valve dysfunction (Botta, 2016).