Surgical repair of ruptured sinus of Valsalva aneurysm: 13‐year single center experience

Abstract

Background and Aim Untreated ruptured sinus of Valsalva aneurysms ultimately develop into heart failure, thereby affecting patients' survival. We retrospectively analyzed our 13‐year experience of the surgical repair for ruptured sinus of Valsalva aneurysm to study the optimal surgical strategy, operative risk and long‐term surgical outcome. Methods Twenty‐six patients underwent surgical repair of ruptured sinus of Valsalva aneurysm from January 2008 to February 2020. Follow‐up data were obtained from the outpatient department records and telephone calls. Results Patch closure of ruptured sinus of Valsalva aneurysm was done in all the 26 patients, most often through the transaortic (69%) and dual‐chamber approach (23%). Aortic valve repair was done in one patient while seven patients underwent aortic valve replacement for associated significant aortic regurgitation. There was one in‐hospital mortality because of noncardiac cause. The median duration of postoperative hospital stay was 8 days (range, 6–11 days). Follow‐up data were available for 89% (23/26) patients. The mean follow‐up period was 69 ± 43 months (range, 7–147 months). All survivors were in New York Heart Association functional Class I or II. There was no late death. One patient required rehospitalization for recurrent ruptured sinus of Valsalva aneurysm. There was no recurrent or new‐onset significant aortic regurgitation and prosthesis‐related complications in late follow‐up. Conclusion Surgical repair for ruptured sinus of Valsalva aneurysm carries an acceptable low operative risk and excellent long‐term outcome. Though high‐risk population, an early diagnosis and optimal surgical approach can prevent worsening of symptoms and consequent heart failure.

Incidental detection of ruptured sinus of Valsalva aneurysm and coronary abnormality in a patient with penetrating chest trauma

“…Both congenital and acquired causes including inflammation and trauma can lead to the rupture the aneurysm 1 . In our patient, proximity of the site of the penetrating chest trauma to the ruptured sinus, evidence of leaflet perforation, and age of onset made a traumatic etiology likely.…”

“…Aneurysms of sinus of Valsalva result from weakened fusion of the medial layer of the aorta and annulus fibrosus of the aortic valve. Progressive dilation and separation of the medial layer from the aortic annulus leads to rupture and formation of fistulous communications between the aortic root and adjacent cardiac chambers 1 . Sinus of Valsalva aneurysms most commonly rupture into the right ventricle but could also rupture into right atrium and pulmonary artery 1 .…”

“…Progressive dilation and separation of the medial layer from the aortic annulus leads to rupture and formation of fistulous communications between the aortic root and adjacent cardiac chambers 1 . Sinus of Valsalva aneurysms most commonly rupture into the right ventricle but could also rupture into right atrium and pulmonary artery 1 . If the rupture involves the right coronary cusp of the aorta, the receiving chamber is usually the right ventricle (70%) and ruptured noncoronary and left coronary cusps frequently drain to the right atrium and the pulmonary artery, respectively 2–4 .…”

“…Closure at only aortic side could lead to aortic deformity and regurgitation and patch closure on both ends to ensure complete obliteration is preferable. Small ruptures without associated anomalies could be occluded by trans‐catheter methods using patent ductus arteriosus and ventricular septal defect occluder devices 1,7–9 …”

“…Aneurysm of sinus of Valsalva is an abnormal dilatation of the aortic root between the aortic annulus and the sinotubular junction. The aneurysm is either congenital or acquired due to inflammatory diseases, endocarditis, trauma, or atherosclerosis 1 . Congenital forms are frequently accompanied by other anomalies including ventricular septal defects.…”