Management of the ruptured sinus of valsalva aneurysmsa

Abstract

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.

Surgical Reconstruction of Valsalva Sinus Aneurysms: One Surgical Team Outcomes from Tertiary Center

“…Most surgeons agree that employing a patch is required, particularly in RSVA because healthy tissue must extend 4-5 mm beyond the apparent rupture hole in order to be properly sutured (15). In 2017, Gupta demonstrated that applying a patch to close a fistula was associated with minimal operating risk, a lower incidence of aortic valve deformation, and high long-term survival (16); however some researchers could not find any relationship between the use of patch in SOV and patients' outcomes (17). However selecting the repair technique is mostly subjective and there is no definite guideline, but in each type of repair function and geometry of aorta must be considered and surgeon must avoid aortic valve distortion (18).…”

Rotura de aneurisma del seno de valsalva coronario derecho en paciente femenino: reporte de caso

“…Dicha recurrencia y el empeoramiento de la aurícula derecha han sido reportados después de un cierre primario. El cierre con parche se recomienda en la RASV (60,3% ± 26,4%) en los casos de reportes revisados ya que evita la deformidad de la válvula aórtica y reduce la presión sobre la línea de sutura 14 El dispositivo de cierre percutáneo de la RASV es una alternativa para traumas menores desde que Cullen reportó el primer caso de cierre transcatéter de la Ruptura del Seno de Valsalva 6 . En este caso se realizó plastía del aneurisma del seno de Valsalva bajo circulación extracorpórea.…”