Surgical repair of a ruptured congenital sinus of Valsalva aneurysm: 10-year experience with 286 cases.

OBJECTIVES: Surgical intervention is the main treatment for a ruptured congenital sinus of Valsalva aneurysm (SVA). However, reports on the surgical experience are scarce. We retrospectively analysed the cases of our centre to summarize our 10-year experience. METHODS: A total of 286 patients who were diagnosed with a congenital ruptured SVA and underwent surgical repair between 2007 and 2016 were identified for the analysis. Follow-up data (mean ± standard deviation: 49.6 ± 34.9 months) were obtained from outpatient department records and telephone calls. RESULTS: The SVAs originated from the right coronary sinus (79.7%), the non-coronary sinus (19.6%) and the left coronary sinus (0.7%) but ruptured into the right ventricle (58.4%) and the right atrium (41.3%). The most commonly associated deformities were a ventricular septal defect (46.3%), aortic valve regurgitation (33.2%) and tricuspid regurgitation (20.3%). The SVA defect was closed by direct suturing (9.1%) or patching (90.9%) through an incision in the cardiac chamber involved or a transaortic approach. The mean postoperative hospital stay duration was 7.2 days, and 98.6% of the patients were discharged in New York Heart Association functional class I or II. The incidence rate of short-term complications was 5.7%. There were 4 late deaths, and 9 patients required rehospitalization due to surgery-related events. The estimated 10-year survival rate was greater than 90% according to the Kaplan-Meier survival curve. CONCLUSIONS: Surgical repair is an effective and safe treatment for a ruptured SVA. The majority of patients who undergo surgical repair can survive for a long time.

Rupture of sinus of Valsalva aneurysm with aorto-biventricular fistulas and right-ventricular outflow tract obstruction: a unique association.

Sinus of Valsalva aneurysms are a rare entity. Rupture of such aneurysms is a major cause of aortocardiac fistulas usually occurring between the right sinus of Valsalva and right cardiac chambers. We report an exceptional case of a ruptured congenital sinus of Valsalva aneurysm with fistulas involving both the right- and left-ventricular outflow tracts and causing RVOT obstruction. We also demonstrate the utility of computed tomography angiography and transesophageal echocardiography in diagnosing these fistulas.

Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm.

BACKGROUND: We reviewed our experience with congenital ruptured sinus of Valsalva aneurysms (RSVA) to determine risk factors influencing occurrence and postoperative worsening of aortic regurgitation (AR). METHODS: Over an 11-year period, 210 patients (33 ± 9.7 years old) underwent surgical repair of RSVA. Aneurysm originated from the right noncoronary sinus and other sinuses in 171, 35 and 4 patients, respectively; and ruptured into right ventricle outlet tract in 115 patients, right ventricle in 16, right atrium in 75, and other chambers in 4. Aortic regurgitation (111) and ventricular septal defect (108) were common coexisting anomalies. Patch closure of RSVA was performed in 61 patients, direct sutures in 18 patients, patch closure plus direct sutures in 88 patients, and repair simultaneous with aortic valve replacement in 43 patients. RESULTS: All but one patient survived the operation. In early postoperative periods, AR improved in 26 patients and worsened in 23. In 114 late follow-up patients with echocardiographic assessment, 18 showed deteriorated AR. By logistic regression analysis, RSVA ruptured into the right ventricle outlet tract and secondary changes of the aortic valve were risk factors for preoperative AR, and RSVA repaired with direct sutures had a significantly higher incidence of early worsening of AR. By Cox regression analysis, AR at discharge was an independent risk factor for late follow-up AR worsening. CONCLUSIONS: The RSVA can be repaired with a low mortality and excellent long-term result. An early, aggressive treatment should be recommended to prevent postoperative AR, and a direct-suture closure of RSVA should be avoided to prevent early worsening of AR.

Echocardiography diagnosis of ruptured congenital right coronary sinus of Valsalva aneurysm into right ventricle.

We describe a case of ruptured aneurysm of the right coronary sinus of Valsalva (ASV) diagnosed by transthoracic two-dimensional echocardiography which allowed to quickly establish a correct diagnosis in a patient with a recent onset of continuous murmur and acute right congestive heart failure.

Congenital aneurysm of sinus of valsalva ruptured into right ventricle diagnosed by magnetic resonance imaging.

Rupture of a congenital aneurysm of the sinus of Valsalva is a rare congenital cardiac malformation. This case report describes a congenital aneurysm of the sinus of Valsalva which ruptured into the right ventricle in a 3-year-old girl. The exact route of the fistula through the cardiac walls and the localization of the rupture into the right ventricle was not completely defined by two-dimensional and color Doppler echocardiography and could be determined only by magnetic resonance imaging (MRI).