Hamid I A, Jothi M, Rajan S, Monro J L, Cherian K M
Department of Cardiac Surgery, Southampton General Hospital, United Kingdom.
J Thorac Cardiovasc Surg. 1994 Jun;107(6):1464-8.
Between 1978 and 1993 a total of 25 cases of ruptured aneurysm of the sinus of Valsalva underwent transaortic repair at the Railway Hospital and the Institute of Cardiovascular Diseases at Madras, India. The aneurysms ruptured into the right ventricle in 20 patients, into the right atrium in 2, into the left ventricle in 1, and into the interventricular septum in 2. They originated from the right coronary sinus in 22 patients and from the noncoronary sinus in 3. Associated congenital anomalies included ventricular septal defect in 21, tetralogy of Fallot in 1, and pulmonary stenosis in 1. All 25 patients underwent transaortic repair of the ruptured sinus of Valsalva, and in patients with a ventricular septal defect the defect also was closed via this route. The patient with associated pulmonary stenosis had a pulmonary valvotomy. The patient with tetralogy of Fallot had infundibular resection, ventricular septal defect closure via a transatrial route, and a right ventricular outflow patch. No intraoperative deaths occurred, but one early death resulted from septicemia and multiorgan failure after rupture of the aneurysm into the interventricular septum with consequent development of extensive intramyocardial and epicardial abscesses. One late death occurred as a result of recurrent subacute bacterial endocarditis and septicemia. Transaortic repair of ruptured aneurysm of the sinus of Valsalva can be accomplished with a low risk of mortality and has the advantage that an associated ventricular septal defect, which frequently accompanies this condition, can be conveniently closed via the same route.
1978年至1993年间，印度马德拉斯铁路医院和心血管疾病研究所共对25例瓦氏窦瘤破裂患者进行了经主动脉修复术。其中20例患者的瘤体破裂进入右心室，2例进入右心房，1例进入左心室，2例进入室间隔。22例患者的瘤体起源于右冠状动脉窦，3例起源于无冠状动脉窦。相关先天性异常包括21例室间隔缺损、1例法洛四联症和1例肺动脉狭窄。所有25例患者均接受了瓦氏窦瘤破裂的经主动脉修复术，对于合并室间隔缺损的患者，缺损也通过该途径进行了修补。合并肺动脉狭窄的患者接受了肺动脉瓣膜切开术。法洛四联症患者接受了漏斗部切除术、经心房途径修补室间隔缺损以及右心室流出道补片修补术。术中无死亡病例，但有1例早期死亡，原因是瘤体破裂进入室间隔后发生败血症和多器官功能衰竭，继而出现广泛的心内膜下和心外膜脓肿。1例晚期死亡是由于复发性亚急性细菌性心内膜炎和败血症。经主动脉修复瓦氏窦瘤破裂可实现低死亡率，且具有可通过同一途径方便地闭合常伴随该疾病的相关室间隔缺损的优点。
