Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Eur J Cardiothorac Surg. 2013 Mar;43(3):591-6. doi: 10.1093/ejcts/ezs450. Epub 2012 Aug 3.
Different surgical strategies have been evolved for the surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA) from simple primary closure to patching of the rupture site by a dual chamber approach. We reviewed our 25-year experience and current literature regarding the efficacy of different surgical approaches.
A retrospective review identified 55 patients who underwent RSVA repair between 1985 and 2011. The mean age was 30.9 ± 12.1 years. The RSVA originated from the right coronary sinus in 43 patients (78.2%), from the non-coronary sinus in 11 (20.0%) and from the left in 1. Rupture into the right ventricle was the most common result (n = 38). Dual-chamber exposure (the involved chamber and aorta) was used in 67.3% of the patients and isolated trans-aortic approach was used in 32.7%. RSVA was repaired with either a patch (n = 43) or direct sutures (n = 12), whereas the aortic valve was replaced in eight patients among the last group.
The hospital mortality rate was 3.6%. The follow-up was available in 94.3% (50 patients) of survivors ranging from 1 month to 25 years (mean 15.3 ± 4.1 years). There were five late deaths. Recurrence of the fistula was seen in two primarily repaired (two of four patients) and none of the patched-closed patients. Actual survival was 93.4 ± 3.7% at 10 years and 87.1 ± 5.6% at 15 years. Freedom from reoperations was 81.6 ± 6.1% at 15 years.
Surgical treatment for RSVA carries an acceptably low operative risk and long-term freedom from death and reoperation. Surgical approach must be chosen according to the ruptured chamber and associated lesions. Patch repair of RSVA must be preferred.
对于破裂的窦房结（Valsalva）动脉瘤（RSVA）的手术治疗，已经发展出了不同的手术策略，从单纯的一期缝合到双腔修补破裂部位。我们回顾了我们 25 年的经验和当前的文献，以了解不同手术方法的疗效。
回顾性分析 1985 年至 2011 年间接受 RSVA 修复的 55 例患者。平均年龄为 30.9 ± 12.1 岁。RSVA 起源于 43 例患者（78.2%）的右冠状动脉窦，11 例患者（20.0%）起源于无冠状动脉窦，1 例起源于左冠状动脉窦。破裂进入右心室是最常见的结果（n = 38）。67.3%的患者采用双腔暴露（受累腔和主动脉），32.7%的患者采用单纯经主动脉入路。RSVA 采用补片修补（n = 43）或直接缝合修补（n = 12），其中最后一组中有 8 例患者更换了主动脉瓣。
住院死亡率为 3.6%。94.3%（50 例）幸存者的随访时间为 1 个月至 25 年（平均 15.3 ± 4.1 年）。有 5 例晚期死亡。初次修补的 2 例（4 例中的 2 例）和修补封闭的患者均未见瘘复发。实际 10 年生存率为 93.4 ± 3.7%，15 年生存率为 87.1 ± 5.6%。15 年无再手术率为 81.6 ± 6.1%。
RSVA 的手术治疗具有可接受的低手术风险和长期免于死亡和再次手术的自由。手术方法必须根据破裂腔和相关病变来选择。RSVA 的修补必须首选。
