Elsevier

The Annals of Thoracic Surgery

Volume 74, Issue 5, November 2002, Pages 1621-1624
The Annals of Thoracic Surgery

Original article: cardiovascular
Ruptured sinus of valsalva aneurysm: a Beijing experience

https://doi.org/10.1016/S0003-4975(02)03987-5Get rights and content

Abstract

Background

Ruptured sinus of Valsalva aneurysm (RSVA) is relatively common in oriental patients. We retrospectively analyzed 67 patients receiving repair of RSVA in a Beijing hospital over 5 years.

Methods

Between October 1, 1996 and September 30, 2001, at Fu Wai Hospital, 67 patients with RSVA underwent surgical repair, 0.78% of all congenital open-heart operations. Forty-four were male and 23 female. Age ranged from 2 to 57 years old (mean 32 ± 10 years). The RSVA originated in the right (n = 52) or noncoronary (n = 15) sinus. Rupture into the right ventricle was most common (n = 39) with 26 going to the right atrium and two to the left ventricle. Associated cardiovascular lesions were ventricular septal defect (n = 32) and aortic valve incompetence (n = 12). Repair was achieved through an incision in the cardiac chamber of the fistula exit in 61 patients. Aortotomy was used in three patients and both routes were used in three patients. The sinus of Valsalva was repaired with either a patch (n = 63) or direct sutures (n = 4). The aortic valve was replaced in 12 patients.

Results

All but 1 patient (n = 66) survived the 30-day operative interval. One patient died of an anticoagulation complication 2 months after the operation. Late complications included residual shunt (n = 2), peri-prosthetic leakage (n = 1), and aortic incompetence (n = 1).

Conclusions

In this relatively high-risk population, repair of RSVA can be achieved with satisfactory early results.

Section snippets

Material and methods

Between October 1, 1996 and September 30, 2001, 67 Chinese patients with RSVA underwent operation at Fu Wai Hospital. This experience constitutes 0.42% of all the heart operations (n = 15,994) and 0.78% of the congenital open-heart operations (n = 8,621) during this 5-year interval. Forty-four were male and 23 were female. Age ranged from 2 to 57 years old (mean 32 ± 10 years; Table 1), and body weight ranged from 13 to 96 kg (mean 62 ± 12 kg). Preoperative signs and symptoms with their

Results

Sixty-six patients survived operation. In the patient who succumbed, an aneurysm ruptured acutely into the RA leading to heart failure and chronic renal dysfunction. Successful emergent repair was achieved with an uneventfully recovery for the first two postoperative days. Five days postoperatively, acute peritonitis, septic shock and acute renal failure developed. The patient died on the eighth postoperative day.

Postoperative complications included: bleeding (n = 2), skin wound infection (n =

Comment

The incidence of acute onset of the symptoms in patients with RSVA is about 35% [2]. In our series, however, we believe the sudden development of palpitation or chest pain in 58% represent a higher percentage of acute onset. The origin, exit, coexistent VSD and coexistent AI do not help us explain this higher percentage.

When an aneurysm ruptures into the RVOT, a coexistent subarterial VSD is likely 1, 3. Exceptions can be explained by the following. If the coexistent subarterial VSD is small

Acknowledgements

The authors thank Dr Donald C. Watson for language editing this manuscript.

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