Aneurysm and fistula of the sinus of Valsalva. Clinical considerations and surgical treatment in 45 patients.

Aneurysms and fistulas of the sinus of Valsalva, although rare, present a challenging surgical problem. Forty-five patients with this lesion have undergone operative treatment during the last 17 years. The series includes 32 male and 13 female patients ranging in age from 2 to 68 years with a mean age of 35.3 years. Only 1 early death occurred in the series, a hospital mortality of 2.2%. Diagnosis of the aneurysm was made preoperatively in 30 patients and discovered at operation 15. The lesion involved the right coronary sinus in 28 patients, the noncoronary sinus in 19, and the left coronary sinus in 5. The aneurysm had not ruptured in 22 patients and had formed a fistulous communication between the right coronary sinus and the right ventricle in 13. Acute rupture occurred in 10 patients (22.2%). Long-term follow-up data were obtained in 38 patients after 1 to 15 years. Late mortality is low. A nonruptured aneurysm of the sinus of Valsalva should be managed conservatively when it occurs as an isolated lesion. Our experience supports the concept that perforated aneurysms and fistulas of the sinus of Valsalva, even if asymptomatic, should be treated operatively.