Harkness James R, Fitton Torin P, Barreiro Chris J, Alejo Diane, Gott Vincent L, Baumgartner William A, Yuh David D
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287-4618, USA.
J Card Surg. 2005 Mar-Apr;20(2):198-204. doi: 10.1111/j.0886-0440.2005.200430.x.
Sinus of Valsalva (SoV) aneurysms are rare (0.15% to 1.5% CPB cases) and five times more frequent in Asians. Usually congenital, SoV aneurysms arise from the right or noncoronary sinus, are associated with other cardiac defects, and are repaired primarily or with a patch. Acquired SoV aneuryms develop secondary to infection or trauma. Here, we describe our 32-year experience with SoV aneurysm repair in a Western population.
A retrospective review identified 22 patients who underwent SoV aneurysm repair between 1971 and 2003. Data is presented as mean +/- standard error (median).
Dyspnea was the most common presenting symptom. Nineteen of 22 patients were ruptured at the time of operation; three were found incidentally. Fifteen patients had associated cardiac defects including ventricular septal defect (VSD) (6), aortic insufficiency (6), and coarctation (3). One patient, repaired primarily, required reoperation for recurrence. All other patients underwent patch repair. The operative survival was 95% (21/22). There were five known late deaths at 6.6 +/- 2.3 (5.7) years post-repair. Five and ten year survival rates were 84.9 +/- 11% and 59.4 +/- 17%, respectively.
Observed differences in the sinus of origin, age at presentation, associated cardiac malformations, and mortality in our Western series versus previous Asian cohort studies likely reflect a racial disparity and higher prevalence of acquired versus congenital SoV aneurysms. We recommend a thorough search for a VSD in all cases and use of patch repair, regardless of size, to reduce risk of recurrence.
瓦尔萨尔瓦窦（SoV）动脉瘤较为罕见（在体外循环病例中占0.15%至1.5%），在亚洲人中的发生率是其他人群的五倍。SoV动脉瘤通常为先天性，起源于右窦或无冠状窦，常伴有其他心脏缺陷，主要通过直接修复或补片修复。后天性SoV动脉瘤继发于感染或创伤。在此，我们描述在西方人群中32年的SoV动脉瘤修复经验。
一项回顾性研究确定了1971年至2003年间接受SoV动脉瘤修复的22例患者。数据以均值±标准误差（中位数）表示。
呼吸困难是最常见的首发症状。22例患者中有19例在手术时动脉瘤已破裂；3例为偶然发现。15例患者伴有心脏缺陷，包括室间隔缺损（VSD）（6例）、主动脉瓣关闭不全（6例）和主动脉缩窄（3例）。1例患者直接修复后因复发需要再次手术。所有其他患者均接受补片修复。手术生存率为95%（21/22）。已知有5例患者在修复后6.6±2.3（5.7）年出现晚期死亡。5年和10年生存率分别为84.9±11%和59.4±17%。
在我们的西方系列研究与之前的亚洲队列研究中，观察到的动脉瘤起源部位、发病年龄、相关心脏畸形及死亡率的差异，可能反映了种族差异以及后天性与先天性SoV动脉瘤患病率的不同。我们建议在所有病例中都要全面检查是否存在VSD，并采用补片修复，无论动脉瘤大小，以降低复发风险。
