Perforated cuspal aneurysm of aortic valve following infective endocarditis presenting as complete heart block: a case report and review of literature

Aortic cuspal aneurysm is a rare clinical entity and often occurs as a complication of infective endocarditis. We report a case of a 30-year-old male with no prior comorbid conditions who presented with fever, acute onset shortness of breath, and chest pain along with multiple episodes of syncope. Electrocardiogram revealed complete heart block while two-dimensional echocardiogram was suggestive of perforated aortic cuspal aneurysm with aortic regurgitation. Blood cultures were positive for Streptococcus viridans. The patient was initiated on broad spectrum antibiotics, temporary pacemaker implantation, and subsequently underwent aortic valve replacement followed by permanent pacemaker implantation after 6 weeks. A diagnosis of perforated aortic cuspal aneurysm subsequent to infective endocarditis was made. This was based on clinical presentation, echocardiographic evaluation, blood cultures, and surgical as well as histopathological findings.