Sinus of valsalva aneurysm or fistula: management and outcome

Takach, Thomas J.; Reul, George J.; Duncan, James M.; Cooley, Denton A.; Livesay, James J.; Ott, David A.; Frazier, O. H.

doi:10.1016/s0003-4975(99)01045-0

Cited by 274 publications

(289 citation statements)

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“…3,4,8 Most frequently it is congenital in origin due to either a congenital absence of continuity between the aortic media and the annulus fibrosus, or a developmental structural defect in the aortic annulus itself which can gradually give way under aortic pressure to form an aneurysm. The aneurysm can rupture into a low pressure cardiac chamber.…”

Section: Discussionmentioning

confidence: 99%

“…1 It commonly originates in the right coronary sinus followed by non-coronary sinus and ruptures into the right ventricle followed by right atrium, which is similar to our experience. [3][4][5] The left coronary cusp does not usually arise from the bulbar septum as do the right and noncoronary cusps, thus explaining the rarity of ruptured left sinus of Valsalva aneurysm. In most of the patients diagnosis is generally made in the third decade and out of them 51-88% are males.…”

Section: Discussionmentioning

confidence: 99%

“…5 The dual chamber approach, though has the advantage of both, but is time consuming process .7,10,15-17 Considering our experience, we advocate the transaortic approach in all the patients as it provides assessment of aortic root, valve leaflets, localization of RSOV, the coronaries and the underlying VSD.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrence of RSOV and worsening of AR has been reported after primary closure. 5,8,10,18 Patch closure of RSOV is recommended (60.3%±26.4%) of cases in reviewed reports) as it avoids deformity of the aortic valve and reduces the stress on the suture line. 5,7,19,20 In our series, we have performed patch closure to repair RSOV with good postoperative results.…”

Section: Discussionmentioning

confidence: 99%

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Management of the ruptured sinus of valsalva aneurysmsa

et al. 2017

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Background: RSOV is associated with a dramatic onset of symptoms to a state of biventricular failure due to sudden volume overload. Controversies exist about RSOV repairs among various centers are the surgical approach (chamber involved, transaortic or both) and the closure technique (primary/ patch closure). There have been no clinical trials to show that one technique is superior to other. In the present study, we reviewed our 16 years’ experience with repair of RSOV through exclusive transaortic approach.Methods: 40 patients underwent RSOV repair through transaortic approach from January 2000 to December 2016. The mean age was 30.2 years. The origin of RSOV was right coronary sinus in 75% of cases and non-coronary sinus in 22.5% of cases. There was one giant calcified unruptured aneurysm arising from right coronary sinus. Right ventricle was most common chamber of rupture comprising 96.67% cases. All patients underwent transaortic repair of RSOV using dacron patch. VSD repair was done in 25% cases. Aortic valve replacement was done in 62.5% cases for moderate to severe AR.Results: There were 7.5% in hospital deaths with no late deaths. Inotropic and ventilatory support required for 3±1.6 days and 1.8±1.2 days respectively. The mean ICU stay and hospital stay was 3.5±1.6 days and 7.5±2.5 days respectively. None of the patient required permanent pacemaker implantation. The 37 survivors were followed up for 6.4±3.6 years; all had an improvement in functional NYHA class with superior results in those with no aortic regurgitation. 7.5% patients developed mild AR during follow up which medical management was done.Conclusions: Surgical treatment of ruptured sinus of Valsalva aneurysm using the transaortic patch technique has an acceptably low operative risk, lesser distortion of aortic valve and good long-term symptom-freedom survival. An early aggressive approach is recommended to prevent worsening of symptoms and more extensive disease.

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Section: Discussionmentioning

confidence: 99%