An 8-month-old man admitted to our hospital for a systolic murmur without any discomfort 4 months ago. Auscultation revealed a Grade 3/6 systolic murmur at the left sternal border (second intercostal space). Transthoracic echocardiography (TTE) showed his quadricuspid pulmonary valve (QPV) was equal to a characteristic ‘+’ configuration (Panels A and B and Supplementary data onlineSupplementary data online, Video S1), indicating a Type A QPV. Severe pulmonary valve stenosis (PS) was indicated by high transvalvular flow velocity (4.4 m/s, Panel C). In the proximal dilated main pulmonary artery from the lateral aspect, an unusual flow was observed (Panels D and E and Supplementary data onlineSupplementary data online, Video S2) with a velocity of 2.4 m/s at diastole (Panel F) indicating a coronary-pulmonary micro-fistulae (CPMF); while bidirectional shunt flow through fossa ovalis indicated patent foramen ovale (PFO) for the patient (Panels G and H). After treatment of percutaneous balloon pulmonary valvuloplasty, the degree of PS went to mild with a transvalvular flow velocity of 2.9 m/s (Panel I), PFO shunt direction turned from the left to right. Due to the small shunt volume of CPMF, only a long-term follow-up was performed.

中文翻译：

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罕见的四尖瓣肺动脉瓣组合。

4个月前，一名8个月大的男子因无任何不适的收缩性杂音入院。听诊发现在胸骨左缘（第二肋间隙）有3/6级收缩期杂音。经胸超声心动图（TTE）显示他的四尖瓣肺动脉瓣（QPV）等于特征性的“ +”配置（面板A和B和在线补充数据，在线补充数据，视频S1），表明A型QPV。严重的肺动脉瓣狭窄（PS）通过高瓣膜流速（4.4 m / s，C组）表示。从侧面看，在近端扩张的主肺动脉中观察到不正常的血流（图D和E在线补充数据，视频S2），舒张期速度为2.4 m / s（图F），表明冠状动脉-肺微瘘管（CPMF）；通过卵圆窝的双向分流指示患者的卵圆孔未闭（PFO）（图G和H）。经皮球囊肺动脉瓣成形术治疗后，PS程度轻度，经瓣静脉流速为2.9 m / s（图I），PFO分流方向从左向右。由于CPMF的分流量较小，因此仅进行了长期随访。