Ruptured aneurysm of sinus of valsalva: clinical manifestations and surgical treatment in eighteen patients

ABSTRACT

Eighteen patients with ruptured aneurysms of sinus of valsalva were operated in the cardiac surgery department of a large tertiary care teaching hospital between January 1991 and December 1996. Male to Female ratio was 81. Age range was 18-40 years with mean of 24. Majority of aneurysms originated from right coronary cusp [67%] and rest from non-coronary cusp [33%]. All right coronary sinus aneurysms opened into right ventricular outflow tract and all non-coronary aneurysms ruptured into right atrium. Associated anomalies were present in eleven cases [61%] comprising VSD in 3 [16.6%], Aortic incompetence in 5 [28%], Sub-aortic membrane in 2 [11%], and Coarctation of Aorta in one [5.5%]. Surgical correction was performed in all patients to close both the defect and the associated lesion. A standard cardio-pulmonary bypass with single aortic and bi-caval cannulation was established. Prolapsing portion of the sinus was excised and repaired simultaneously through aorta and the involved chamber. There were no perioperative deaths. Follow-up ranged from 4 months to 5 years with an average of 3.5. None of the patients required re-operation. We conclude that in patients with ruptured aneurysm of Sinus of Valsalva, dual approach is a better surgical option with minimal operative risk and excellent long term results: