Surgical repair in ruptured congenital sinus of Valsalva aneurysms: A 13-year experience

Background and aim of the study: Rupture of congenital sinus of Valsalva an eurysm is a rare cardiac malformation that usually causes reduced cardiac p erformance. Methods: Twenty patients (mean age 28.3 +/- 10.7 years; range: 14 to 55 yea rs) with rupture of congenital sinus of Valsalva aneurysm were operated on at our institution between January 1985 and March 1999. The origin of the r uptured aneurysms was the right coronary sinus in 18 patients (90%) and the non-coronary sinus in two (10%). No ruptures were observed originating fro m the left coronary sinus. The aneurysms ruptured into the right ventricle in 14 patients (70%), into the right atrium in five (25%), and into the lef t ventricle in one patient (5%). Subarterial ventricular septal defect (VSD ) was the most common associated defect (30%), and aortic insufficiency the second (20%). No correlation was found between subarterial VSDs and aortic insufficiency (p >0.05). To achieve repair, the aorta and cavity into whic h the aneurysm had ruptured were opened. The aneurysmal sac was excised and the defect closed with a patch in 18 patients, and without patch in two. Results: One patient died in hospital (mortality rate 5%); no late mortalit y was observed. Surviving patients were followed up for 4.4 +/- 3.3 years ( range: 1 to 13 years). The actuarial survival rate was 95% at 12.35 years. Recurrence of fistula was observed in one patient (5%) in whom the ruptured aneurysm had been closed by primary suture without the use of a patch. At 12.35 years, the actuarial freedom from recurrence of fistula was 94.74% fo r all survivors, and 100% for patients with patch closure. No late complica tions have been observed. Conclusions: Following diagnosis:of ruptured sinus of Valsalva aneurysm, su rgical repair is the treatment of choice. Surgery performed as rapidly as p ossible after diagnosis in general leads to an excellent outcome.