Discussion
The incidence of cardiovascular syphilis, which was high during the
first half of the 20th century due to the lack of effective treatment,
decreased significantly after the introduction of penicillin to treat
syphilis 1-3. Since the beginning of the 21st century,
however, the incidence of syphilis has increased
annually.4 Tertiary syphilis is less common today,
perhaps owing to the widespread use of antibiotics.5,
6 Cardiovascular syphilis is a late complication of untreated tertiary
syphilis, affecting an estimated 7.4% of these
patients.5 Most patients with cardiovascular syphilis
have aortic insufficiency, aortic aneurysm, and/or coronary ostial
stenosis.7-8 However, dissecting aneurysms of the
sinus of Valsalva are very rare.
A quadricuspid aortic valve is an uncommon congenital valve lesion, and
the incidence of aortic regurgitation increases with age in patients
with this lesion; however, surgery can be used to replace the aortic
valve until the fifth or sixth decade of life.9 The
patient described in the current report was young and had not been
previously treated for syphilis or an aortic valve defect. The
combination of syphilis with a quadricuspid aortic valve may have
resulted in the dissecting aneurysm of the sinus of Valsalva. In our
report, echocardiography and cardiac CT provided high quality anatomic
detail for precise diagnosis. Multiformat reconstructions and volume
rendered techniques were useful for pre-operative planning.