亚洲患者瓦尔萨尔瓦窦瘤的外科修复术。

Surgical repair of sinus of Valsalva aneurysm in Asian patients.

作者信息

Wang Zheng-jun, Zou Cheng-wei, Li De-cai, Li Hong-xin, Wang An-biao, Yuan Gui-dao, Fan Quan-xin

机构信息

Department of Cardiac Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China.

出版信息

Ann Thorac Surg. 2007 Jul;84(1):156-60. doi: 10.1016/j.athoracsur.2007.03.022.

DOI:10.1016/j.athoracsur.2007.03.022

PMID:17588403

Abstract

BACKGROUND

Sinus of Valsalva aneurysm is a rare cardiac anomaly, and the difference between Asian and Western countries in its occurrence is not well established. This study was designed to investigate the difference between Asian and Western patients.

METHODS

Between September 1988 and February 2006, 83 patients with sinus of Valsalva aneurysm underwent surgical repair in our institute. The aneurysms originated from the right and noncoronary sinus in 74 and 9, respectively, and ruptured into the right ventricle in 52 patients, the right atrium in 30, and the left ventricle in 1. Ventricular septal defect (n = 38), aortic regurgitation (n = 21), and bicuspid aortic valve (n = 4) were the common coexisting anomalies. To compare the differences between Asian and Western patients in sinus of Valsalva aneurysm, 1049 cases (654 Asian patients versus 395 Western) were collected from the literature.

RESULTS

Sixty-six patients were followed up for 9.6 +/- 3.8 years. The cardiac function of 15 patients with aortic regurgitation was worse than that of those with no aortic regurgitation (p < 0.05). There was no difference between the direct closure and the patch closure (p > 0.05). Analysis of all collected cases revealed that aneurysm of the sinus of Valsalva in Asian patients compared with Western series is characterized by a higher incidence, more aneurysms originating from the right coronary sinus (85.8% versus 67.9%), more aneurysm rupture into the right ventricle (72.5% versus 60%), a higher incidence of association with ventricular septal defect (52.4% versus 37.5%), and lower incidence of association with bicuspid aortic valve (0.6% versus 7.8%). However, both Asian and Western patient series have similar incidence of combination with aortic regurgitation (33.6% versus 32.7%).

CONCLUSIONS

Long-term results of ruptured sinus of Valsalva aneurysm are associated with preoperative aortic regurgitation. The difference between Asian and Western patients with ruptured aneurysm of the sinus of Valsalva is significant.

摘要

背景

瓦尔萨尔瓦窦瘤是一种罕见的心脏畸形，亚洲和西方国家在其发生率上的差异尚未明确。本研究旨在调查亚洲和西方患者之间的差异。

方法

1988年9月至2006年2月期间，我院对83例瓦尔萨尔瓦窦瘤患者进行了手术修复。动脉瘤分别起源于右窦和无冠窦，其中74例起源于右窦，9例起源于无冠窦，52例破裂入右心室，30例破裂入右心房，1例破裂入左心室。室间隔缺损（n = 38）、主动脉瓣反流（n = 21）和二叶式主动脉瓣（n = 4）是常见的合并畸形。为比较亚洲和西方患者在瓦尔萨尔瓦窦瘤方面的差异，从文献中收集了1049例病例（654例亚洲患者与395例西方患者）。

结果

66例患者接受了9.6±3.8年的随访。15例主动脉瓣反流患者的心脏功能比无主动脉瓣反流患者差（p < 0.05）。直接缝合和补片缝合之间无差异（p > 0.05）。对所有收集病例的分析显示，与西方系列相比，亚洲患者的瓦尔萨尔瓦窦瘤具有以下特点：发生率更高，更多的动脉瘤起源于右冠状动脉窦（85.8%对67.9%），更多的动脉瘤破裂入右心室（72.5%对60%），与室间隔缺损相关的发生率更高（52.4%对37.5%），与二叶式主动脉瓣相关的发生率更低（0.6%对7.8%）。然而，亚洲和西方患者系列中合并主动脉瓣反流的发生率相似（33.6%对32.7%）。