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.