Long-term Result after Repair of Sinus Valsalva Aneurysm Rupture / 대한흉부외과학회지

BACKGROUND: Sinus valsalva aneurysm (SVA) is a rare disease, and it is frequently accompanied by ventricular septal defect and aortic valve regurgitaion. For treatment of SVA, several surgical mordalities were applied, but there was no report on the long-term result after surgical repair in Korea. We reviewed our 28 years of experiences and analyzed the long-term results after treatment of sinus valsalva aneurysm with or without rupture. MATERIAL AND METHOD: Between March 1974 and February 2002, 81 patients were operated under the impression of sinus valvsalva aneurysm or sinus valsalva aneurym rupture. Retrospectively we reviewed the patients' record. Mean age of patients was 29.2+/-11.5 and there were 49 males. Accompanyng diseases were as follows: VSD in 50, PDA in 2, Behcet's disease in 2, TOF in 1, RVOTO in 1, AAE in 1. Seventy-seven (95%) patients had sinus valsalva rupture and in 14 patients, subacute bacterial endocarditis was accompanied. Degree of aortic valve regurgitation was as follows: grade I: 8, II: 10, III: 9, IV: 4. Most common rupture site was right coronary sinus (66 patients, 81%) and most common communication site was right ventricle (53 patients). In repair of sinus valsalva rupture, patch was used in 37 patients, and direct suture was done in 38 patients. RESULT: There was one surgical death (1.2%). Follow up was done in 78 patients (97.5%), mean follow up period was 123.3+/-80.9 (3~330 months). During the follow up period, 3 patients died (3.8%). One patient died of heart failure, another patient died of arrhythmia and the other one died of unknown cause. In two patients, complete atrio-ventricular block was developed during follow up period, and there was no operation related event or complication. Kaplan-Meier survival analysis revealed 92.5+/-3.5% survival at 15 and 27 years and it seems to be satisfactory. CONCLUSION: Long-term surgical results and survival is satisfactory after repair of sinus valsalva aneurysm with or without rupture.

Aneurysm of the Sinus of Valsalva Dissecting into the Ventricular Septum Associated with Paravalvular Leakage After Double Valve Replacement / 대한흉부외과학회지

We experienced a case of aneurysm of the sinus of Valsalva dissecting into the ventricular dseptum. This dissection was induced by paravalvular leakage after aortic and mitral valve replacement. This 37-year-old male was admitted via emergency room due to progressive dyspnea. He had undergone aortic valve replacement(carbomedic(R) 23 mm) and mitral valve replacement(carbomedic(R) 31 mm) due to aortic regurgitation and mitral regurgitation about 6 years prior to admission and followed up regularly. The diagnosis was made by transthoracic and transesophageal echocardiography and reconfirmed by root aortography. The inlet of the ventricular septal aneurysmal sac was repaired by one layer suture with 3-0 prolene of the endocardium, epicardium and homograft muscle shoulder altogether. Postoperative course was uneventful and the patient was discharged on the 11th postoperative day.