Elsevier

The Annals of Thoracic Surgery

Volume 68, Issue 5, November 1999, Pages 1573-1577
The Annals of Thoracic Surgery

Original Articles
Sinus of valsalva aneurysm or fistula: management and outcome

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
https://doi.org/10.1016/S0003-4975(99)01045-0Get rights and content

Abstract

Background. Few large or long-term series exist regarding the management of patients with sinus of Valsalva aneurysms or fistulas (SVAFs).

Methods. Between 1956 and 1997, 129 patients presented with a ruptured (64 cases; 49.6%) or nonruptured (65 cases; 50.4%) SVAF. The patients included 88 men and 41 women, with a mean age of 39.1 years. Associated findings included a history of endocarditis (42 cases; 32.6%), a bicuspid aortic valve (21 cases; 16.3%), a ventricular septal defect (15 cases; 11.6%), and Marfan’s syndrome (12 cases; 9.3%). Operative procedures included simple plication (61 cases; 47.3%), patch repair (52 cases; 40.3%), aortic root replacement (16 cases; 12.4%), and aortic valve replacement/repair (75 cases; 58.1%).

Results. There were five in-hospital deaths (3.9%): four due to preexisting sepsis and endocarditis and one that followed dehiscence of the repair in a patient with Marfan’s syndrome. Two patients (1.6%) had strokes during the early postoperative period. The survivors were followed up for 661.1 patient-years (5.3 years/patient). The following late complications occurred: prosthetic valve malfunction (5 cases; 3.9%), prosthetic valve endocarditis (3 cases; 2.3%), SVAF recurrence (2 cases; 1.6%), thrombosis (1 case; 0.8%), and anticoagulation-related bleeding (1 case; 0.8%).

Conclusions. Resection and repair of SVAF entails an acceptably low operative risk and yields long-term freedom from symptoms. Early, aggressive treatment is recommended to prevent endocarditis or lesional enlargement, which causes worse symptoms and necessitates more extensive repair.

Section snippets

Material and methods

We reviewed the hospital records and postoperative clinical charts of 129 consecutive patients with 149 SVAFs treated at our institution between April 1956 and January 1997. When necessary, supplemental information was obtained from the patient’s private cardiologist and family.

The series included 88 men (68.2%) and 41 women (31.8%), whose average age at operation was 39.1 years (range 2 to 74 years). With respect to New York Heart Association functional status, 8 patients were in class I

Results

Perioperative adverse events included five in-hospital deaths (3.9%): four (3.1%) that were secondary to preexisting sepsis and endocarditis, and one (0.8%) that followed dehiscence of the primary repair in a patient with Marfan’s syndrome. Two patients (1.6%) had strokes but completely recovered their neurologic function before being discharged from the hospital. All 124 survivors were symptom free at hospital discharge.

The late follow-up period totaled 661.1 patient-years (5.3 years/patient).

Comment

Because of the relative infrequency of SVAFs, investigators have not accurately determined the natural history of these lesions. Abbott [11] and Edwards and Burchell [12] have provided evidence of a congenital etiology. They have suggested that the lesion is due to a structural deficiency in the media related to the development of the distal bulbar septum 11, 12. Others have described an “acquired” etiology, marked by degeneration of the media secondary to syphilis [7], infection [13],

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