Objective To introduce a modified Sakakibara classification system for a ruptured sinus of Valsalva aneurysm （RSVA），and suggest different surgical approaches for corresponding types of RSVA. Methods Clinical data of 159 patients undergoing surgical repair for RSVA in Fu Wai Hospital between February 2006 and January 2012 were retrospectively analyzed. There were 105 male and 54 female patients with their age of 2-71 （33.4±10.7） years. All these patients were divided into 5 types as a modified Sakakibara classification system. Type I: rupture into the right ventricle just beneath the pulmonary valve （n=66），including 84.8% patients with ventricular septal defect （VSD） and 53.8% patients with aortic valve insufficiency （AI）. TypeⅡ：rupture into or just beneath the crista supraventricularis of the right ventricle （n=17），including 88.2% patients with VSD and 23.5% patients with AI. Type Ⅲ：rupture into the right atrium （typeⅢ a，n=21） or the right ventricle （typeⅢv，n=6） near or at the tricuspid annulus，including 18.5% patients with VSD and 25.9% patients with AI. TypeⅣ：rupture into the right atrium （n=46），including 23.9% patients with AI but no patient with VSD. TypeⅤ：other rare conditions，such as rupture into the left atrium，left ventricle or pulmonary artery （n=3），including 100% patients with AI and 33.3% patients with VSD. Most RSVA originated in the right coronary sinus （n=122），and others originated in the noncoronary sinus （n=35） or left coronary sinus （n=2）. Results All the type V patients （100%） and 50% patients with typeⅢv received RSVA repair through aortotomy. In most patients of typeⅠ，II andⅣ，repair was achieved through the cardiac chamber of the fistula exit （71.2%，64.7% and 69.6% respectively）. Both routes of repair were used in 76.2% patients with typeⅢ a. The cardiopulmonary bypass time （92.4±37.8 minutes） and aortic cross-clamp time （61.2±30.7 minutes） was the shortest to repair typeⅣRSVA. There was no in-hospital death in this group. Two patients （type I andⅡrespectively） underwent reoperation during the early postoperative period because of restenosis of the right ventricular outflow tract. Most patients received reinforcement patch for RSVA repair （n=149），and only 10 patients received simple suture repair （including 5 patients with typeⅣ，4 patients with typeⅢ a and 1 patient with typeⅡ）. Aortic valve replacement was performed for 33 patients （66.7% of those with typeⅠ）. A total of 147 patients （92.5%） were followed up after discharge. Two patients （type I andⅢ a respectively） developed atrial fibrillation and received radiofrequency ablation treatment，1 patient （typeⅣ） underwent reoperation for residual shunt，and there was no late death during follow-up. Conclusion Modified Sakakibara classification system for RVSA provides a guidance to choose an appropriate surgical approach，and satisfactory clinical outcomes can be achieved for all types of RSVA.
【摘要】 目的 探讨主动脉窦瘤破裂（RSVA）的临床特点、诊断及外科治疗方法。 方法 2004年1月-2009年12月对28例RSVA患者在体外循环下行RSVA修补术，同期行室间隔缺损修补术18例，房间隔缺损修补术4例，主动脉瓣成形术2例，主动脉瓣置换术4例。术后随访3个月～6年，平均32.4个月。 结果 28例患者均无手术死亡和残余分流。失访4例。心功能Ⅰ级20例，Ⅱ级4例；复查心脏彩色超声心动图无主动脉窦瘤复发或残余分流，主动脉瓣轻-中度反流2例。 结论 外科手术是RSVA的最有效治疗方法，窦瘤破口直径gt;0.5 cm者宜用补片修补。伴有中或重度主动脉瓣关闭不全时需根据主动脉瓣病变程度以及手术者经验决定，必要时需放宽换瓣指征。【Abstract】 Objective To evaluate the clinical characteristics, diagnosis, and surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA). Methods Twenty-eight patients with RSVA were treated surgically in extracorporeal circulation. Repair of RSVA with patch were taken in all patients while closure of ventricular septal defect (VSD) in 18 patients, closure of atrial septal defect (ASD) in four patients, aortic angioplasty (AA) in two patiens and replacement of aortic valve in four patients. Results There was no death and no residue leak after operation. The patients were followed-up for 24 patients, ranged from three months to six years, with the average 32.4 months. The cardiac function of 20 patients was found to be of NYHA classⅠand four patients of classⅡ. Review the heart colour echocardiography, there was no residual tumor or sinus and aortic regurgitation light-moderate in two patients. Conclusions Surgery is the most effective treatment for RSVA, the breaches of sinus tumor in diametergt;0.5 cm is used to repair. When the patients with moderate or severe aortic regurgitation, whether it is necessary to relax in disc indications depends on the degree of aortic disease and performer’s experience.
ObjectiveTo summarize surgical treatment experience on unruptured aneurysm of the sinus of Valsalva (SVA). MethodsClinical data of 33 patients with unruptured SVA underwent surgical repair at Fu wai Hospital between February 2007 and January 2012 were retrospectively analyzed. There were 27 males and 6 females with their mean age of 28.5±13.5 years (ranged from 4.5 to 58.0 years). The unruptured SVA originated in the right coronary sinus in 29 cases (87.8%), in non-coronary in 2 cases (6.1%) and in left coronary sinus in 2 cases (6.1%). There were 29 cases with ventricular septal defect and 20 cases with aortic valve insufficiency (AI). ResultsOnly 52.8% of unruptured SVA were correctly diagnosed by echocardiography preoperatively. All unruptured SVA received active surgical management, with no early death after operation. Thirty patients (90.9%) were followed up for 22 to 81 months (mean 42.9±18.8 months) and in NYHA classⅠorⅡ. None SVA recurrence occurred. Postoperative AI could be improved better by using the repair route only through the chamber of right ventricle for patients with unruptured SVA originated in right coronary sinus. ConclusionFor unruptured SVA patients who associated with other kinds of cardiovascular lesions, active surgical repair for unruptured SVA can achieve satisfactory results.
The patient underwent prostatectomy before two months. After the operation, he suffered from intermittent fever, chest tightness, and suffocation. Combined with the history, symptoms, signs, laboratory examination, echocardiography, imaging examination (CT), and the positive blood culture for Enterococcus faecalis, the admitting diagnosis was aortic stenosis and insufficiency, mitral insufficiency, cardiac function grade Ⅲ (New York Heart Association grade), infective endocarditis, and aneurysm of aortic sinus. After 4-week antimicrobial drug treatment, the patient was in a stable condition with normal body temperature, multiple negative blood cultures, and normal laboratory-related examinations. After careful and sufficient preparation, transcatheter aortic valve replacement operation was performed in the hybrid operating room with 32 mm Venus-A valve. The operation was successful and the patient was discharged on the seventh day after operation. He continued to be treated with antimicrobial drugs for 4 weeks after surgery, and his temperature was normal. He had no chest tightness, asthma, or other symptoms. One, three, and six months after operation, blood tests and erythrocyte sedimentation rate were normal, electrocardiogram showed sinus rhythm, and echocardiography showed a maximum aortic valve pressure difference of 7 mm Hg (1 mm Hg=0.133 kPa), no perivalvular leak and no pericardial effusion.