Reversible Complete Atrioventricular Block Due to Rupture of the Left Coronary Aortic Sinus.

BACKGROUND

Rupture of the left coronary aortic sinus complicated by conduction disturbances has not been reported.

CASE SUMMARY: An 85-year-old woman presented with chest and back pain and a complete atrioventricular block, which led to low-output syndrome. Imaging revealed a rupture of the left coronary aortic sinus with a pseudoaneurysm and a hematoma extending toward the central fibrous body. Conservative management was selected, and atrioventricular conduction gradually improved as the hematoma regressed.

DISCUSSION: The hematoma compressed the atrioventricular node region, causing a reversible atrioventricular block. Infective endocarditis, antineutrophil cytoplasmic antibody-associated vasculitis, atherosclerosis, and localized dissection involving the sinuses of Valsalva have been discussed as potential mechanisms underlying this rare condition.

TAKE-HOME MESSAGE: Spontaneous rupture of the sinuses of Valsalva and the resultant hematoma extending around the central fibrous body can cause a reversible complete atrioventricular block by mechanical compression of the atrioventricular node region.