Severe Calcific Bicuspid Aortic Valve Stenosis Presenting as Reversible Complete Heart Block

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe calcific bicuspid aortic valve stenosis with complete heart block (n=1). Intervention: Surgical aortic valve replacement. Primary outcome: Reversal of complete heart block.

Q: What does this research mean for the field?

Severe calcific bicuspid aortic valve stenosis can cause complete heart block that is reversible following surgical aortic valve replacement, potentially avoiding the need for permanent pacemaker implantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Pramod Tulshidas Gitte; Milind Kharche; Umesh Khedkar; Sumit Rawal

doi:10.1016/j.jaccas.2026.108558

June 1, 2026JACC Case ReportsOpen Access

Severe Calcific Bicuspid Aortic Valve Stenosis Presenting as Reversible Complete Heart Block

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Key result

SAVR reverses complete heart block in severe bicuspid aortic stenosis, avoiding permanent pacemaker implantation.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Severe calcific bicuspid aortic valve stenosis rarely presents with complete heart block, though subvalvular calcium can compress the atrioventricular conduction axis.

Key Points

Evaluate the clinical presentation, mechanism, and reversibility of complete atrioventricular heart block caused by subvalvular calcification in severe bicuspid aortic valve stenosis.
A 42-year-old man presenting with presyncope, dyspnea, and complete atrioventricular dissociation was evaluated using echocardiography and computed tomography aortography.
The patient underwent surgical aortic valve replacement with a 23-mm mechanical prosthesis, accompanied by debridement of subvalvular calcium and temporary epicardial pacing.
Preoperative Doppler imaging confirmed severe stenosis with a peak velocity of 5.4 m/s and a peak/mean gradient of 116/53 mm Hg.
Postoperative intrinsic conduction recovered progressively to sinus rhythm with left bundle branch block morphology, permitting removal of temporary pacing wires by day 6.
At 3-month follow-up, the patient maintained sinus rhythm with a functioning mechanical prosthesis exhibiting a peak/mean gradient of 28/16 mm Hg.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 42-year-old man with severe calcific bicuspid aortic valve stenosis presenting with complete heart block, treated with surgical aortic valve replacement and followed for 3 months.

I

Intervention

Surgical aortic valve replacement (SAVR) using a 23-mm mechanical prosthesis with meticulous surgical debridement of subvalvular calcium and temporary epicardial pacing.

O

Outcome

Restoration of intrinsic atrioventricular conduction and resolution of complete heart block.

Severe calcific bicuspid aortic valve stenosis can present with reversible complete heart block due to calcium extension into the conduction system, and early surgical correction can restore atrioventricular conduction without the need for a permanent pacemaker.

Implication

May identify reversible complete heart block before pacing in calcific bicuspid stenosis; leaves open generalizability beyond isolated cases.

Abstract

BACKGROUND: Severe calcific bicuspid aortic valve (BAV) stenosis rarely presents with complete heart block, although extensive subvalvular calcium may compress the atrioventricular conduction axis. CASE SUMMARY: A 42-year-old man presented with presyncope and dyspnea, and his electrocardiogram showed complete atrioventricular dissociation with a ventricular escape rhythm. Echocardiography and computed tomography aortography demonstrated severe calcific type 0 BAV stenosis, with dense calcium extending into the membranous septum. Surgical aortic valve replacement with a mechanical prosthesis was performed. Postoperatively, the patient showed progressive restoration of intrinsic conduction, and temporary pacing wires were removed by day 6. At 3-month follow-up, he remained asymptomatic in stable sinus rhythm with a well-functioning prosthetic valve. DISCUSSION: This case highlights severe calcific BAV stenosis as an uncommon but reversible cause of complete heart block. TAKE-HOME MESSAGE: Early recognition of this mechanism is essential to prevent unnecessary permanent pacemaker implantation and underscores the value of multimodality imaging in evaluating conduction abnormalities.

Discussion

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Cite This Study

Gitte et al. (2026) conducted a case report in Severe calcific bicuspid aortic valve stenosis with complete heart block (n=1). Surgical aortic valve replacement was evaluated on Reversal of complete heart block. Surgical aortic valve replacement completely reversed complete heart block in a 42-year-old man with severe calcific bicuspid aortic valve stenosis, avoiding permanent pacemaker implantation.

synapsesocial.com/papers/6a61c413b8617574e1f53cb1 https://doi.org/10.1016/j.jaccas.2026.108558

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Severe Calcific Bicuspid Aortic Valve Stenosis Presenting as Reversible Complete Heart Block

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Severe Calcific Bicuspid Aortic Valve Stenosis Presenting as Reversible Complete Heart Block

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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