Lev's disease: insidious enemy of conduction system/Ileti sisteminin sinsi düsmani: Lev hastaligi

A 60-year-old previously hypertensive gentlemen presented with progressive dyspnea. Electrocardiography showed atrial fibrillation with left bundle branch block. Cardiac catheterization revealed normal coronary arteries, severe aortic and mitral regurgitation. Despite mild calcification of aortic valve we noted a band-like calcification arising from aortic valve, extending into and outlining the bundle of His, and probably proximal part of the left bundle (Fig. 1, 2, Video 1. See corresponding video/movie images at www.anakarder.com).

Lev's disease is often accompanied by aortic valve calcification that may invade the bundle of His, the right and/or left bundle branch. Progressive loss of myocytes lead to conduction defects including atrioventricular and bundle branch blocks.