Surgery for ruptured sinus of Valsalva aneurysm: Five-year experience with 19 patients

Amac: Bu yazida rupture sinus Valsalva anevrizmasi (RSVA) tamirindeki bes yillik deneyimimiz ve yama ile kapamanin etkinligine iliskin mevcut literatur incelendi. Ca­lis­ma­pla­ni:­Retrospektif bir incelemeyle Ocak 2009 ve Ekim 2013 tarihleri arasinda RSVA tamiri gecirmis 19 hasta (15 erkek, 4 kadin; ort. yas 28±12; dagilim 14-55 yas) belirlendi. Rupture sinus Valsalva anevrizmasi 17 hastada (%89.4) sag koroner sinusten, iki hastada (%10.5) nonkoroner sinusten kaynaklanmaktaydi. Rupture sinus Valsalva anevrizmasi hastalarin hicbirinde sol koroner sinusten kaynaklanmamaktaydi. On bir hastada (%57.8) en yaygin olay sag ventrikul rupturuyken sekiz hastada (%42.10) sag atriyum rupturuydu. Yaygin iliskili defektler iki hastada (%10.7) subaortik ventrikuler septal defekt, yedi hastada (%36.8) aort yetmezligi ve bir hastada (%5.2) trikuspid yetmezligi idi. Onarim icin bikameral yaklasim kullanildi. Rupture sinus Valsalva anevrizmasi tum olgularda genisletilmis politetrafloroetilen yama ile onarildi. Yedi hastada aort kapagi, bir hastada trikuspid degistirildi. Bul gu lar: Hastane mortalite orani %5.2 idi. Suresi bir ay ila 4.5 yil arasinda degisen takip, sag kalanlarin %94.3’u (n=18) ile yapildi. Gercek sagkalim orani %95 idi. Tekrar ameliyattan uzak yasam orani %100 idi. So­nuc:­ Rupture sinus Valsalva anevrizmasi icin en iyi tedavi seceneginin cerrahi tamir oldugu anlasilmaktadir. Tanidan sonra hizli cerrahi girisim basarili sonuclar saglayabilir. Anah tar soz cuk ler: Asiyanotik dogustan kalp hastaligi; yama tamiri; rupture anevrizma; sinus Valsalva anevrizmasi. Background:­ In this article, we reviewed our five-year experience in the repair of ruptured sinus of Valsalva aneurysm (RSVA), and the current literature regarding the efficacy of patch closure. Methods: A retrospective review identified 19 patients (15 males, 4 females; mean age 28±12 years; range 14 to 55 years) who underwent RSVA repair between January 2009 and October 2013. The RSVA originated from the right coronary sinus in 17 patients (89.4%), and from the noncoronary sinus in two patients (10.5%). Ruptured sinus of Valsalva aneurysm did not originate from the left coronary sinus in any of the patients. In 11 patients (57.8%), the most common occurrence was right ventricular rupture, whereas it was right atrial rupture in eight patients (42.10%). Common associated defects were subaortic ventricular septal defect in two patients (10.7%), aortic insufficiency in seven patients (36.8%), and tricuspid insufficiency in one patient (5.2%). A bicameral approach was used for repair. Ruptured sinus of Valsalva aneurysm was repaired with an expanded polytetrafluoroethylene patch in all cases. Aortic valve was replaced in seven patients, and tricuspid in one patient. Results:­The hospital mortality rate was 5.2%. Follow-up, ranging from one month to 4.5 years, was available in 94.3% of survivors (n=18). Actual survival rate was 95%. Freedom from reoperation was 100%. Conclusion:­ To conclude, surgical repair appears to be the optimal choice for the treatment of RSVA. Rapid surgical intervention after diagnosis may lead to successful outcomes.