Surgical correction for sinus of Valsalva aneurysm

BACKGROUND: To evaluate the efficacy of surgical correction of sinuses of Valsalva aneurysms, 24 patients operated on from 1974-1994 were reviewed. Mean age was 42.2+/-16.7 years; 17 were males. METHODS: Right coronary sinus was affected in 13 patients and noncoronary sinus in 8. Intracardiac fistula was detected in 16 patients: into the right atrium in 8; right ventricle in 5; left ventricle in 2; and left atrium in 1. Repair was performed via an aortic approach in 11 patients and a combined aortic and intracardiac approach in 13 patients. Suture closure of the fistula was via the aortic side in 10 cases and the intracardiac side in 6. Ten patients had patch closure via the aortic side. RESULTS: Follow-up was 92% complete at a mean of 8.4 years with 3 late cardiac and 1 noncardiac deaths. Eighty-eight percent of patients are in New York Heart Association functional class I or II; none underwent reoperation. CONCLUSIONS: Sinuses of Valsalva aneurysm repair have low operative mortality and morbidity risks with excellent early and late results. Surgical approach is dependent upon the presenting pathology.     

Austrian triad with sinus of Valsalva aneurysm and rupture

An interesting case of a young patient presenting with Austrian's Triad: pneumococcal pneumonia, pneumococcal meningitis, and pneumococcal endocarditis. On echocardiogram the patient was noted to have a noncoronary sinus of Valsalva aneurysm and vegetations on the aortic cusps resulting in disruption of valvular integrity and severe aortic insufficiency. Color Doppler also revealed rupture of the aneurysm into the right atrium. The patient was taken to surgery where the noncoronary cusp was noted to be completely replaced with vegetative lesions. The aortic valve was replaced with a No. 21 Carpentier-Edwards bioprosthetic valve (Edwards Lifesciences, Irvine, CA), and the noncoronary sinus of Valsalva was repaired with concomitant closure of the fistula using glutaraldehyde autologous pericardium.     

Surgical repair of ruptured aortic sinus of Valsalva aneurysm

Surgical repair of ruptured aortic sinus of Valsalva aneurysm was performed on six patients. The NYHA functional class was I in one case, II in three and III in two cases. All aneurysms had ruptured into the right atrium. Three originated from the right, and three from the non-coronary aortic sinus of Valsalva. The preoperative shunt was 55-200% (mean 118%) of the peripheral cardiac output. At aneurysmal repair, closure of secundum-type atrial septal defect was performed in one case and insertion of a St Jude Medical aortic valve in another. There were no perioperative deaths. Five patients were asymptomatic in the follow-up period (5 months-17 years). One patient died of cardiomyopathy 11 years postoperatively. The long-term results after surgical repair of ruptured aortic sinus of Valsalva aneurysm thus were good, and early operation is recommended in order to avoid congestive heart failure.     

Repair of intrapericardial rupture of left sinus of Valsalva aneurysm

A 62-year-old man with no history of preexisting heart disease was seen in cardiogenic shock. Prompt cardiac catheterization and aortography revealed pericardial tamponade and aneurysms of the right and left sinuses of Valsalva. Immediate sternotomy relieved the tamponade, which was secondary to an aneurysm of the left sinus of Valsalva rupturing into the transverse pericardial sinus. Endoaneurysmorrhaphy was performed successfully.     

主动脉窦瘤破入右心房的外科治疗效果

目的 总结主动脉窦瘤破入右心房的外科治疗经验,比较经右心房切口、右心房联合主动脉切口两种途径修补的结果.方法 2004年1月至2009年12月共对53例主动脉窦瘤破入右心房的患者进行了外科手术,其中男性35例,女性18例;年龄15～63岁,平均(33±9)岁.其中经右心房途径修补40例(Ⅰ组);经右心房联合主动脉切口修补13例(Ⅱ组).比较两组在心肺转流时间、主动脉阻断时间、呼吸机辅助时间、ICU时间、术后住院时间方面的差异.结果 两组在心肺转流时间[(86±29)min比(96±30)min]、主动脉阻断时间[(59±29)min比(71±25)min]、呼吸机辅助时间[(9±4)h比(161±23)h]、ICU时间[(35±23)h比(35±23)h]、术后住院时间[(7.1±0.9)d比(7.8±2.8)d]方面的差异无统计学意义(P＞0.05).随访1～64个月,平均(32±21)个月.术后随访无死亡,1例术前合并感染性心内膜炎的患者,术后6个月出现主动脉瓣大量反流需手术治疗;1例术后44个月查出冠状动脉粥样硬化性心脏病应用药物治疗,其余患者心功能(NYHA分级)Ⅰ～Ⅱ级.结论 外科治疗主动脉窦瘤破入右心房可取得良好的疗效,经右心房切口、右心房联合主动脉切口两种途径修补效果相当.     

Surgical repair and long-term results in ruptured sinus of Valsalva aneurysm

Thirty-one patients with a ruptured sinus of Valsalva aneurysm (SVA) were operated on between January, 1961, and December, 1987. Twenty-five patients (81%) were in New York Heart Association (NYHA) Functional Class III or IV. Coexistent cardiac anomalies included a ventricular septal defect (VSD) in 16 patients (52%) and aortic valve regurgitation in 12 patients (39%). The ruptured SVA originated from the right coronary sinus in 29 patients (94%) and the noncoronary sinus in 2 patients (6%), and drained into the right ventricle in 30 patients (97%). In 6 patients treated recently, we used patches to repair the ruptured SVA and VSD through a double approach, thereby avoiding a ventriculotomy. This method resulted in no recurrent rupture or residual VSD postoperatively. There was one operative death (3%) and 4 late deaths (13%). Of the 26 surviving patients, 22 (85%) were in NYHA Class I at follow-up ranging from 6 months to 26.7 years (mean, 11.1 years). Actuarial survival at 25 years is 85.6 +/- 7.4% (mean +/- standard deviation). Repair of ruptured SVA with a patch through a double approach provides an excellent operative procedure and offers a long-term outcome.     

Surgical repair of a sinus of a Valsalva aneurysm ruptured into the left ventricle

A 47-year-old man presented with orthopnea. He had no infection or, in particular, infectious endocarditis. An echocardiogram and multislice computed tomography scan revealed a left sinus of Valsalva aneurysm (SVA) that had ruptured into the left ventricle, with severe aortic regurgitation. He was diagnosed with ruptured congenital SVA with severe aortic regurgitation and underwent closure of the aneurysmal mouth with a Dacron patch, and concomitant aortic valve replacement. The use of a Dacron patch to close the aneurysmal mouth of a ruptured congenital left SVA has not been reported previously in the medical literature.     

Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique

Background  

Rupture of aneurysms of the sinus of Valsalva results in abrupt onset of congestive heart failure. On-pump beating-heart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Herein, we report the operative correction of thirty-one patients of ruptured aneurysms of the sinus of Valsalva, using the on-pump beating-heart technique.     

Surgical repair of postoperative left sinus of Valsalva aneurysm dissecting into the interventricular septum

We describe the dissection of the interventricular septum by unruptured aneurysm of the left sinus of Valsalva in a patient who had undergone aortic valve replacement for rheumatic aortic valve insufficiency 5 years previously. The patient had worn a permanent pacemaker for 1 year to manage complete atrioventricular block. Sufficient information was provided by echocardiography and aortography to confirm the diagnosis. Operative correction consisted of obliteration of the aneurysm sac and closure of the outward orifice with a Dacron patch from the side of the aortic sinus.     

Surgical correction of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva: case report and review of the literature

We report a quite rare case of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva with no clinical findings of Marfan syndrome or Ehlers–Danlos syndrome. A 52-year-old Chinese male was diagnosed having an aneurysm of the right sinus of Valsalva and moderate aortic regurgitation, while Bentall operation was performed successfully. The patient was discharged with no complications. Pathological examination revealed conspicuously medial mucoid degeneration of the aneurismal wall and absence of medial elastic fibers. Immediate results and early follow-up were uneventful.