Xiao Jia-Wang, Wang Qi-Guang, Zhang Duan-Zhen, Cui Chun-Sheng, Han Xiumin, Zhang Po, Hou Chuangju, Zhu Xian-Yang
Department of Congenital Heart Disease, General Hospital of Shenyang Military Command, Shenyang, People's Republic of China.
Congenit Heart Dis. 2018 Mar;13(2):305-310. doi: 10.1111/chd.12572. Epub 2018 Feb 5.
To evaluate the clinical efficacy, safety, and long-term outcomes of percutaneous closure (PC) and surgical repair of ruptured sinus of Valsalva aneurysm (RSVA).
Eighty-five consecutive patients with RSVA were included in this study. Patients were considered candidates for PC if they met the criterion, surgical repair was performed on patients who were unsuitable or failed PC. Of them, 30 patients underwent PC, while the other 55 patients had surgical repair.
RSVA was successfully occluded in 29 of 30 patients who were treated by PC. The mean narrowest diameter at the ruptured site was 6.45 ± 1.60 mm measured by aortography. One patient developed serious occluder-related aortic regurgitation and underwent surgery. The success rate of the interventional approach was 96.7%. In the surgical group, 23 patients underwent repair of combined RSVA and ventricular septal defect. The hospital mortality rate of the surgical approach was 3.57%. During a median follow-up of 83 months (8-152 months), the improvement in NYHA functional class in the PC group was significantly greater than those in the surgical group (P < .01). One patient died of infective endocarditis in the surgical group. There were no further serious complications.
PC is a safe alternative to surgical repair for patients with isolated RSVA. Surgical repair is more suitable for those who have multiple cardiac lesions requiring surgical treatment or failed PC.
评估经皮封堵术（PC）与手术修复法洛四联症（RSVA）破裂的临床疗效、安全性及长期预后。
本研究纳入了85例连续性RSVA患者。符合标准的患者被视为PC候选者，对不适合或PC失败的患者进行手术修复。其中，30例患者接受了PC，另外55例患者进行了手术修复。
30例接受PC治疗的患者中，29例RSVA成功封堵。经主动脉造影测量，破裂部位的平均最窄直径为6.45±1.60mm。1例患者出现严重的封堵器相关主动脉瓣反流并接受了手术。介入治疗的成功率为96.7%。在手术组中，23例患者接受了RSVA合并室间隔缺损的修复。手术治疗的医院死亡率为3.57%。在中位随访83个月（8 - 152个月）期间，PC组纽约心脏协会（NYHA）心功能分级的改善明显大于手术组（P < 0.01）。手术组有1例患者死于感染性心内膜炎。无进一步严重并发症。
对于孤立性RSVA患者，PC是手术修复的安全替代方法。手术修复更适合那些有多种心脏病变需要手术治疗或PC失败的患者。
