Shah R P, Ding Z P, Ng A S, Quek S S
Department of Cardiology, Gleneagles Medical Centre, Penang, Malaysia.
Singapore Med J. 2001 Oct;42(10):473-6.
Rupture of the sinus of valsalva (RSOV) is an uncommon condition with a variety of manifestations ranging from an asymptomatic murmur to cardiogenic shock. This retrospective 10-year review (1985-1995) of 18 patients from a single institution revealed that 6 (33%) were female and 12 (67%) were male with a mean age of 37.6 +/- 13.4 years and that 72% were Chinese by ethnic descent with the remaining 28% being Malay. Eight patients (44.4%) presented with an asymptomatic murmur, 4 (22.2%) with acute chest pain, 4 (22.2%) with mild heart failure, 2 (11.1%) with severe heart failure, and 2 (11.1%) with cardiogenic shock. Rupture of the right aneurysmal coronary cusp (RCC) made up 15 (83.3%) while those of the non-coronary cusp (NCC) made up the remaining. Most of the RCC ruptures were directed into the right ventricle and all of the NCC ruptures were into the right atrium. Ventricular septal defects (VSDs) were found in 9 (50%) of the patients, (although detected by echocardiography in only one third of those patients), aortic regurgitation in 6 (33.3%) and aortic valve vegetations in 2 (11.1%). Echocardiography was found to be accurate in diagnosing RSOVs with 100% diagnostic accuracy after 1990 with four misdiagnoses before 1990. Of these four patients, two were misdiagnosed as having VSDs, one as having a coronary arteriovenous fistula and one as having a patent ductus arteriosus. The anatomical structure of the "windsock" was seen in 64% of the patients who were correctly diagnosed. The pattern of colour flow and spectral Doppler was seen in all patients and helped to localise the site of rupture and the direction of flow. In summary, echocardiography is a simple and accurate way of diagnosing and defining RSOVs and is the imaging modality of choice.
瓦氏窦破裂（RSOV）是一种罕见病症，有多种表现形式，从无症状杂音到心源性休克不等。对某一机构18例患者进行的这项回顾性10年研究（1985 - 1995年）显示，6例（33%）为女性，12例（67%）为男性，平均年龄37.6±13.4岁，72%为华裔，其余28%为马来裔。8例患者（44.4%）表现为无症状杂音，4例（22.2%）表现为急性胸痛，4例（22.2%）表现为轻度心力衰竭，2例（11.1%）表现为重度心力衰竭，2例（11.1%）表现为心源性休克。右冠状动脉瘤样窦破裂（RCC）占15例（83.3%），其余为无冠状动脉窦破裂（NCC）。大多数RCC破裂破入右心室，所有NCC破裂均破入右心房。9例（50%）患者发现室间隔缺损（VSD）（尽管仅三分之一的患者通过超声心动图检测到），6例（33.3%）有主动脉瓣反流，2例（11.1%）有主动脉瓣赘生物。超声心动图在诊断RSOV方面被发现是准确的，1990年后诊断准确率达100%，1990年前有4例误诊。在这4例患者中，2例被误诊为VSD，1例被误诊为冠状动静脉瘘，1例被误诊为动脉导管未闭。64%正确诊断的患者可见“风袋”的解剖结构。所有患者均可见彩色血流和频谱多普勒模式，有助于确定破裂部位和血流方向。总之，超声心动图是诊断和明确RSOV的一种简单而准确的方法，是首选的成像方式。
