Sinus of valsalva aneurysm or fistula: Management and outcome

Background. Few large or long-term series exist regarding the management of patients with sinus of Valsalva aneurysms or fistulas (SVAFs). Methods. Between 1956 and 1997, 129 patients presented with a ruptured (64 cases; 49.6%) or nonruptured (65 cases; 50.4%) SVAF. The patients included 88 men and 41 women, with a mean age of 39.1 years. Associated findings inc luded a history of endocarditis (42 cases; 32.6%), a bicuspid aortic valve (21 cases; 16.3%), a ventricular septal defect (15 cases; 11.6%), and Marfa n's syndrome (12 cases; 9.3%). Operative procedures included simple plicati on (61 cases; 47.3%), patch repair (52 cases; 40.3%), aortic root replaceme nt (16 cases; 12.4%), and aortic valve replacement/repair (75 cases; 58.1%) . Results. There were five in-hospital deaths (3.9%): four due to preexisting sepsis and endocarditis and one that followed dehiscence of the repair in a patient with Marfan's syndrome. Two patients (1.6%) had strokes during th e early postoperative period. The survivors were followed up for 661.1 pati ent-years (5.3 years/patient). The following late complications occurred: p rosthetic valve malfunction (5 cases; 3.9%), prosthetic valve endocarditis (3 cases; 2.3%), SVAF recurrence (2 cases; 1.6%), thrombosis (1 case; 0.8%) , and anticoagulation-related bleeding (1 case; 0.8%). Conclusions. Resection and repair of SVAF entails an acceptably low operati ve risk and yields long-term freedom from symptoms. Early, aggressive treat ment is recommended to prevent endocarditis or lesional enlargement, which causes worse symptoms and necessitates more extensive repair. (C) 1999 by T he Society of Thoracic Surgeons.