https://orcid.org/0000-0002-5400-6980
A 39-year-old man with no medical history presented to the emergency department with dizziness that had started 2 days earlier. Electrocardiogram showed complete heart block (Figure 1A).
Electrocardiograms on admission and after surgery (panels A and F respectively), the parasternal long axis view of the transthoracic echocardiogram (panel B), cardiac CT and 3D reconstruction (panels C and D respectively) and pictures of the surgery after median sternotomy from the anesthesiologist's visual perspective (panel E). Blue star: pseudo-aneurysm; blue arrow: right sinus of Valsalva; red arrow: pseudo-aneurysm bleeding into interventricular septum. Ao, aorta; LA, left atrium; LV, left ventricle; RCA, right coronary artery.
The patient was haemodynamically stable on admission without isoprenaline, and physical examination was normal with no chest pain. Potassium and troponin levels were normal.
Transthoracic echocardiogram showed a pseudo-aneurysm (blue star) of the right sinus of Valsalva (blue arrow) without aortic dilatation or aortic regurgitation (Figure 1B).
We performed a cardiac computed tomography (Figure 1C and D), which confirmed the rupture of the right sinus with a pseudo-aneurysm bleeding into the interventricular septum (red arrow).
The patient underwent emergency surgery with removal of the pseudo-aneurysm just below the right coronary artery (Figure 1E) and aortic root replacement with mechanical Bentall procedure.
Post-operative care was uneventful. We observed regression of the atrioventricular (AV) block on Day 2 with persistent right bundle branch block and left anterior fascicular block (Figure 1F).
The patient was discharged on Day 10 without the need for a pacemaker.
This case highlights an unusual reversible cause of AV block, which was most likely due to mechanical compression of the His bundle by a ruptured right coronary sinus aneurysm into the interventricular septum.
Funding: None declared.
Data availability
No new data were generated or analysed in support of this research.
Lead author biography
My name is Amélie Marang. I am a cardiologist at the Centre Hospitalier d’Annecy Genevois in France. I graduated from medical school in 2017 at the Université Paris Descartes in Paris and then studied my specialty in cardiovascular medicine at Université de Tours, where I graduated in 2022. I am currently working as a non-invasive cardiologist in the cardiac intensive care unit and wish to specialize in cardiac critical care.
Author notes
Conflict of interest: None declared.
