Original article
Cardiovascular
Surgical Repair of Sinus of Valsalva Aneurysm in Asian Patients

https://doi.org/10.1016/j.athoracsur.2007.03.022Get rights and content

Background

Sinus of Valsalva aneurysm is a rare cardiac anomaly, and the difference between Asian and Western countries in its occurrence is not well established. This study was designed to investigate the difference between Asian and Western patients.

Methods

Between September 1988 and February 2006, 83 patients with sinus of Valsalva aneurysm underwent surgical repair in our institute. The aneurysms originated from the right and noncoronary sinus in 74 and 9, respectively, and ruptured into the right ventricle in 52 patients, the right atrium in 30, and the left ventricle in 1. Ventricular septal defect (n = 38), aortic regurgitation (n = 21), and bicuspid aortic valve (n = 4) were the common coexisting anomalies. To compare the differences between Asian and Western patients in sinus of Valsalva aneurysm, 1049 cases (654 Asian patients versus 395 Western) were collected from the literature.

Results

Sixty-six patients were followed up for 9.6 ± 3.8 years. The cardiac function of 15 patients with aortic regurgitation was worse than that of those with no aortic regurgitation (p < 0.05). There was no difference between the direct closure and the patch closure (p > 0.05). Analysis of all collected cases revealed that aneurysm of the sinus of Valsalva in Asian patients compared with Western series is characterized by a higher incidence, more aneurysms originating from the right coronary sinus (85.8% versus 67.9%), more aneurysm rupture into the right ventricle (72.5% versus 60%), a higher incidence of association with ventricular septal defect (52.4% versus 37.5%), and lower incidence of association with bicuspid aortic valve (0.6% versus 7.8%). However, both Asian and Western patient series have similar incidence of combination with aortic regurgitation (33.6% versus 32.7%).

Conclusions

Long-term results of ruptured sinus of Valsalva aneurysm are associated with preoperative aortic regurgitation. The difference between Asian and Western patients with ruptured aneurysm of the sinus of Valsalva is significant.

Section snippets

Patient Profile

During the 18-year period from September 1988 to February 2006, 83 patients (55 males and 28 females) underwent surgical repair for aneurysm of the sinus of Valsalva, which comprised 1.2% of the 6831 open heart operations performed in Shandong Provincial Hospital during this period. The Ethics Committee approved this study and waived the need for individual patient consent.

The mean age of patients at repair was 30.7 ± 12.1 years (range, 3 to 69 years). At the time of admission, 71 patients

Surgical Results of the Present Series

In the present series, there was no hospital mortality. The postoperative hospital length of stay was 14.3 ± 6.4 days before 1997 and 10.8 ± 2.5 days after 1997. The postoperative mechanical ventilation support time was 9.2 ± 4.8 hours. Postoperative complications included skin wound infection in 4 patients, arrhythmia in 4, bleeding in 3 (cardiac tamponade in 1 patient), and 1 patient each with VSD residual shunt, right pneumothorax, and acute left-sided heart failure for severe aortic valve

Comment

Aneurysm of the sinus of Valsalva is a rare congenital heart disease that constitutes about 0.14% to 1.5% of congenital heart repairs [22]. It is uncommonly associated with endocarditis, atherosclerosis, syphilis, or aortic dissection [23]. Because the aortic valve occupies a central position in the base of the heart, an SVA can rupture into any of the four heart chambers, especially into right atrium and right ventricle. Occasionally, it ruptures into the pulmonary artery [24, 25] or

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