A 31 year old man presented with intermittent dizziness and electrocardiographic evidence of a severe conduction disturbance, with asystolic pauses of up to six seconds, and was treated by implantation of a permanent pacemaker. Echocardiography showed an enlarging aneurysm of the right sinus of Valsalva extending into the interventricular septum. This was confirmed by aortography, and successful surgical repair was carried out. The characteristic diastolic expansion of the aneurysm and the demonstration of continuity between the septal extension and the related aortic sinus were useful diagnostic features.
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