ANEURYSMS OF THE SINUS OF VALSALVA

Objective. To evaluate the properties of the coexistent cardiac anomal ies associated with the aneurysm of simus of Valsalva (ASV) and examin e the long-term surgical results after operation. Patients. From 1980 to 1994, nine patients (median age 22 years) underwent surgical correc tion of ASV. Aneurysms originated from the right (n=5), noncoronary (n =3) and left coronary sinus (n=1) and entered into right ventricle (n= 5), right atrium (n=3). In one patient, ASV originated from the left c oronary sinus and unruptured. Coexistent cardiac lesions were aortic v alve insufficiency (n=4), ventricular septal defect (n=5), patent fora men ovale (n=1), right ventricular outflow tract obstruction (n=1) and coronary artery anomaly (n=2). All patients were symptomatic (sudden onset of symtoms in 3, gradual onset in 6). Interventions. Ruptured AS Vs were repaired by double-approach in which both the involved chamber and the aortic root. Concomitant aortic surgery was performed in four patients (2 replacement, 2 valvuloplasty). VSDs were closed by patch in 4 and by direct suture in 1. Results. The incidence of coexisting c oronary artery anomaly was 22.2%. There was no hospital and late morta lity. The mean follow-up period was 6.8 years (range 1 to 14 years). T here were no reoperation for leaks of VSD, recurrence of aneurysm and aortic regurgitation. Eight patients were found to be in New York Hear t Association class I, one patient in class II. Conclusion. The risk o f the recurrent fistula or VSD is prevented by double approach techniq ue, and also this approach reduces the incidence of late aortic insuff iciency. Routinely preoperative coronary angiography must be performed for determine of coronary anomaly.