Azakie A, David T E, Peniston C M, Rao V, Williams W G
Division of Cardiovascular Surgery, The Toronto General Hospital, University of Toronto, Ontario, Canada.
Ann Thorac Surg. 2000 Nov;70(5):1466-70; discussion 1470-1. doi: 10.1016/s0003-4975(00)01734-3.
We reviewed our experience with congenital ruptured sinus of Valsalva aneurysms (RSVA) to determine patterns of early recurrence and the fate of the aortic valve (AV).
Over a 28-year period, RSVA was identified in 34 patients, (mean age 31.6 years). Primary closure of the RSVA was performed in 10 patients, and a patch employed in 24. Aortic insufficiency was present in 24 patients. AV replacement (AVR) was performed in 5 patients; AV repair in 6.
Follow-up of 9.2 +/- 8.3 years (6 months to 24 years) was complete in all but 2 patients. Five early fistula recurrences (in 4 patients) correlated with primary rather than patch closure (p < 0.03). Kaplan-Meier survival at 10 years is 90 +/- 7%. Freedom from reoperative AVR at 10 years is 83 +/- 9%. Late AVR was performed in 6 patients for progressive aortic insufficiency due to bicuspid valve (n = 3), cusp disease of affected sinus (n = 2), or aortic root dilatation (n = 2).
Patch closure of the RSVA should be routinely employed. A bicuspid valve may be associated with the late need for AVR.
我们回顾了我们处理先天性瓦氏窦瘤破裂（RSVA）的经验，以确定早期复发模式及主动脉瓣（AV）的转归。
在28年期间，共确诊34例RSVA患者（平均年龄31.6岁）。10例患者行RSVA一期闭合术，24例使用补片。24例患者存在主动脉瓣关闭不全。5例行主动脉瓣置换术（AVR）；6例行主动脉瓣修复术。
除2例患者外，其余所有患者均完成了平均9.2±8.3年（6个月至24年）的随访。5例（4名患者）早期瘘管复发与一期闭合而非补片闭合相关（p<0.03）。10年的Kaplan-Meier生存率为90±7%。10年无再次手术AVR的概率为83±9%。6例患者因以下原因后期行AVR：二尖瓣病变（n=3）、患侧窦瓣叶病变（n=2）或主动脉根部扩张（n=2）导致的进行性主动脉瓣关闭不全。
RSVA应常规采用补片闭合术。二尖瓣病变可能与后期需要行AVR有关。
