Kuriakose Emy M, Bhatla Puneet, McElhinney Doff B
Department of Pediatric, New York University Langone Medical Center, New York, New York.
Department of Pediatric, New York University Langone Medical Center, New York, New York.
Am J Cardiol. 2015 Feb 1;115(3):392-8. doi: 10.1016/j.amjcard.2014.11.013. Epub 2014 Nov 13.
Sinus of Valsalva aneurysm is a rare cardiac malformation that stems from incomplete fusion of the aortic media and the aortic valve annulus, a weakness that may result in rupture of the sinus, large left-to-right shunt, and severe congestive heart failure. Historically, this lesion has been repaired surgically, but percutaneous closure (PC) has emerged as a therapeutic intervention over the last 20 years. We review and contrast 34 studies detailing the PC approach with 16 studies on surgical closure (SC), together comprising a total of 877 patients who were treated for ruptured sinus of Valsalva aneurysm from 1956 to 2014. Both groups had similar sites of rupture, age distribution, and clinical symptoms at presentation. Selection bias ultimately prohibits a direct comparison between the 2 groups as patients who underwent SC often had worse aortic regurgitation and more complex associated lesions, including endocarditis, bicuspid aortic valve, tunnel-type fistulous connections, larger defect size, and multiple site of rupture. In conclusion, although SC is indicated and reserved for these more complicated patients, our review of previously published reports reveals that PC in patients who are too ill to undergo bypass, with mild or no aortic regurgitation and simple associated defects (muscular ventricular septal defects, secundum atrial septal defect, small patent ductus arteriosus), can be safe, effective, and practical.
瓦氏窦瘤是一种罕见的心脏畸形，它源于主动脉中层与主动脉瓣环融合不完全，这种薄弱可能导致窦破裂、大量左向右分流以及严重的充血性心力衰竭。从历史上看，这种病变一直通过手术修复，但在过去20年中，经皮封堵术（PC）已成为一种治疗手段。我们回顾并对比了34项详细介绍经皮封堵术方法的研究与16项关于手术闭合（SC）的研究，这些研究共纳入了1956年至2014年期间接受瓦氏窦瘤破裂治疗的877例患者。两组患者的破裂部位、年龄分布及就诊时的临床症状相似。由于接受手术闭合的患者通常主动脉反流更严重且伴有更复杂的相关病变，包括心内膜炎、二叶式主动脉瓣、隧道型瘘管连接、缺损尺寸更大以及多处破裂，选择偏倚最终使得两组之间无法进行直接比较。总之，虽然手术闭合适用于这些更复杂的患者，但我们对既往发表报告的回顾显示，对于病情过重无法进行旁路手术、伴有轻度或无主动脉反流以及简单相关缺损（肌部室间隔缺损、继发孔型房间隔缺损、小型动脉导管未闭）的患者，经皮封堵术可以是安全、有效且实用的。
