Calcified unruptured aneurysm of sinus of Valsalva with complete heart block and aortic regurgitation. Successful repair in one case.

SUMMARY A case is presented of a calcified aneurysm of the sinus of Valsalva extending into the interventricular septum. Complete atrioventricular block and aortic regurgitation were associated. The patient, a 37 year old black African, was successfully operated upon by patch closure of the orifice of the aneurysm, aortic valve replacement, and permanent pacemaker insertion. We report a patient with a calcified unruptured aneurysm of the right coronary sinus of Valsalva, with an extension into the interventricular septum producing complete heart block and aortic regurgitation. Successful surgical repair was achieved by patch closure of the aneurysm, aortic valve replacement, and permanent pacemaker insertion. Case report A 37 year old black African man was first admitted to the hospital in 1975. At this time moderate aortic regurgitation was recognised. The patient was in functional class II, had moderate cardiomegaly (cardio-thoracic ratio: 0 56), with a calcified contour in the area of aortic root, and electrocardiographic findings consistent with trifascicular block. Cardiac catheterisa-tion and aortography showed moderate aortic regurgi-tation. Because of the quality of the angiogram at that time, the aneurysm of the sinus of Valsalva was not clearly identified. The patient was readmitted in 1977 because of complete heart block and a transvenous pacemaker was inserted. In December 1980, he was again readmitted with increasing dyspnoea. There were no signs of congestive heart failure but a slow heart rate was present and on auscultation a grade 3/6 diastolic murmur was heard. The electrocardiogram confirmed that the heart was paced at 60 beats a minute. There was cardiomegaly on chest x-ray (cardiothoracic ratio: 0 70). As in 1975, the same calcified contour of the aortic root was visible (Fig. 1). The patient had a temporary pacemaker lead inserted, and underwent catheterisation. Right atrial and ventricular pressures were normal. In the aorta, the systolic pressure was 160 mmHg, the diastolic 60 mmHg. The left ventricle could not be entered. The cardiac output was 2-24 1/min and the cardiac index was 1-4 1/min per M2. The aortic angiograms showed moderate to severe aortic regurgitation; a large non-pulsatile aneurysm of the sinus of Valsalva, with calcified borders; the origin of the aneurysm could not be clearly determined but there was an extension of the aneurysm into the interventricular septum. This extension was pulsatile and had not ruptured into a cardiac cavity (Fig. 2). At operation, after establishment of cardio-pulmonary bypass between the venae cavae and …