15- to 30-Year Follow-up of Patients Undergoing Repair of Ruptured Congenital Aneurysms of the Sinus of Valsalva

Barragry, T. P.; Ring, W. Steves; Moller, James H.; Lillehei, C. Walton

doi:10.1016/s0003-4975(10)64688-7

Cited by 43 publications

(23 citation statements)

References 17 publications

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“…1 The long-term surgical outcomes for RSVA are generally good with 85% patients in New York Heart Association Functional Class I or II. 3,6,12 Vural et al proposed an algorithmdependent classification for the timing for surgical repair. 13 Recently the transcatheter technique has been used to close RSVA.…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Closure of a Ruptured Sinus of Valsalva Aneurysm

Chang

Chiu

et al. 2006

Circ J

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uptured sinus of Valsalva aneurysms (RSVA) are rare and usually occurs in adolescence to early adulthood. 1 They are most commonly congenital in origin and caused by a weakness of the wall of the sinus Valsalva above the aortic valve annulus and leads to progressive dilatation, eventually rupturing into one of the 4 chambers of the heart or the mediastinum. 2 The aneurysm most commonly arises from the right coronary sinus (RCS) of Valsalva and most frequently ruptures into the right ventricle with a wind-sock like structure projecting from the sinus into which it ruptures. Surgical repair is the traditional treatment for RSVA. 3 With the advent of the transcatheter technique, transcatheter closure of the RSVA could be an alternative treatment. We report the results of transcatheter treatment of RSVA in 4 patients. with sudden-onset exertional dyspnea and palpitation. Bounding pulses and a continuous murmur could be detected in all patients. The diagnosis of RSVA is based on transthoracic 2-dimensional (D) echocardiography with color Doppler and angiography. Two patients had a cardiac chamber dilatation. All 4 patients underwent attempted transcatheter closure of the RSVA after obtaining consent from the patient or parents. Methods ProceduresUnder local anesthesia, the femoral vein and artery were cannulated with a sheath. Heparin (50 units/kg) was administered before the procedure and one dose of cephradine arginine was given. Hemodynamic studies and angiography were performed in all patients to calculate the pulmonaryto-systemic ratio (Qp:Qs) and to delineate the morphology of RSVA and the opening site (Fig 1). After general anesthesia, transesophageal echocardiography (TEE) was performed to monitor the procedure. The maximal diameter of the aortic opening of the RSVA was measured on multiplane TEE images. The distance between the aortic opening site of the RSVA and the right or left coronary ostium was also measured on TEE images. A 5 or 6Fr right Judkin catheter was advanced from the right femoral artery to the ostium of the RSVA. A 0.014 coronary extra-support guidewire (Boston Scientific, SCIMED, Natick, MA, USA) with a soft and floppy end was advanced through the catheter into the right atrium or the main pulmonary artery. A 10-mm Goose Neck Snare (Microvena, White Bear Lake, MN, USA) was advanced through the right femoral venous sheath, snared the coronary guidewire in the right atrium or the main pulmonary artery, and exteriorized the coronary wire through the right femoral vein. An arteriovenous rail

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Section: Discussionmentioning

confidence: 99%

“…Surgical repair is the traditional treatment for RSVA. 3 With the advent of the transcatheter technique, transcatheter closure of the RSVA could be an alternative treatment. We report the results of transcatheter treatment of RSVA in 4 patients.…”

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confidence: 99%

Transcatheter Closure of a Ruptured Sinus of Valsalva Aneurysm

Chang

Chiu

et al. 2006

Circ J

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“…Therefore, open surgical repair is obligatory following the diagnosis of SVAR. Many centres have reported both their short-and long-term results (1,3,9) . Long-term surgical repair of SVARs can be performed with low mortality and morbidity (10) .…”

Section: Discussionmentioning

confidence: 99%

“…Prior opinions considered the opening of a single area during repair to be sufficient. However, it is contemporarily believed that opening the areas from which the aneurysm originates and the aneurysm ruptures into will assist in better understanding of the pathology and more accurate repair (3,9) . In this case, we used a doublesided approach by opening the aorta and the infundibulum.…”

Section: Discussionmentioning

confidence: 99%

Surgical Repair of a Ruptured Sinus of Valsalva Aneurysm Complicated by Ventricular Septal Defect and Aortic Valve Insufficiency

Özen¹

2017

Kosuyolu Heart Journal

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A 23-year-old male patient was admitted with a 2-week history of congestive heart failure. An echocardiogram revealed an aneurysm originating from the right sinus of Valsalva with a small perforated area on the edge, a ventricular septal defect and severe aortic valve insufficiency. A decision for surgery was made. The right sinus of Valsalva was repaired from the inside. The infundibulotomy was closed using a continuous suturing technique and pericardial patch was used incorporating the ventricular septal defect and the previously repaired right sinus of Valsalva. The aortic valve was replaced with a mechanical prosthesis. Follow-up was unproblematic, and he was discharged on the 12 th postoperative day. Aortic valve insufficiency and a high output shunt cause an increase in the ventricular diameter, impairment of the ejection fraction, congestive heart failure and resultant pulmonary pathology. Ventricular enlargement or impaired ejection fraction does not necessarily deem these patients inoperable.

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“…Long-term follow-up suggests that there may be a high incidence for complete heart block, endocarditis, aortic regurgitation, and recurrent rupture. However, 5-year survival has been reported as high as 86% [29][30][31].…”

Section: Discussionmentioning

confidence: 99%