We report two cases of a quadricuspid aortic valve with severe aortic incompetence. Both patients presented with dyspnea on exertion. Their physical examinations demonstrated wide pulse pressures with diastolic murmurs. Bedside transthoracic Doppler echocardiography revealed preserved left ventricular systolic function and possible quadricuspid aortic valve with severe aortic incompetence in both patients. We proceeded with transesophageal echocardiography that confirmed a quadricuspid aortic valve with severe aortic incompetence in both patients. Left ventricular systolic function was preserved in both cases. Both patients had a preoperative cardiac catheterization, which showed normal coronary arteries. They were referred to cardiothoracic surgery and underwent successful aortic valve replacement with bioprosthetic valves.