SURGICAL REPAIR OF RUPTURED SINUS OF VALSALVA ANEURYSM: EXPERIENCE AT CARDIOVASCULAR DEPARTMENT, LADY READING HOSPITAL, PESHAWAR
PDF

How to Cite

Malik, A., babar, tariq, Khalil, I., Shah, M., & Laiq, N. (2014). SURGICAL REPAIR OF RUPTURED SINUS OF VALSALVA ANEURYSM: EXPERIENCE AT CARDIOVASCULAR DEPARTMENT, LADY READING HOSPITAL, PESHAWAR. KHYBER MEDICAL UNIVERSITY JOURNAL, 6(3). Retrieved from https://www.kmuj.kmu.edu.pk/article/view/13258

Abstract

Objectives: To determine the frequency of ruptured sinus of Valsalva aneurysm (SVA) and to study its surgical outcome in terms of morbidity and mortality in our set up.

Methodology: This case series study was conducted on 23 patients of ruptured SVA’s, were operated at  cardiovascular department, Lady reading hospital, Peshawar, from January 2003 to December 2011 and followed up till December 2013. Informed consent was taken  from all patients. Surgical repair was performed using cardiopulmonary bypass (CPB) via a median sternotomy. Age, sex, presentation, site and outcome of surgical repair were analyzed.

Results: Ruptured SVA’s was more common in males (73.91%). Right coronary cusp was involved in 86.95% patients of the ruptured SVA’s cases. Most common ruptured site was right ventricle (91.30%). Aortic regurgitation was observed in 21.73% and ventricular septal defects in 13.04% cases. Primary closure of the defect with pladgeted stiches done in 86.95% cases while patch closure was done in 13.05% cases. Preoperatively, 34.78% & 52.17% patients were having NYHA functional status III & IV respectively, while postoperatively 45.45% & 36.36% patients were having NYHA functional status I & II respectively. Mortality was 4.35% (n=1/23) and one (4.35%) patient had residual leak and managed conservatively. Two years follow up showed no complication regarding ruptured SVA.

Conclusions:  SVA are very uncommon anomalies in our setup, commonly involve right coronary cusp and rupturing mostly into right side of heart. Surgical repair of VSA is a safe procedure having good outcome in terms of morbidity and mortality.

PDF

References

Sarikaya S, Adademir T, Elibol A, Büyükbayrak F, Onk A, Kirali K. Surgery for ruptured sinus of Valsalva aneurysm: 25-year experience with 55 patients. Eur J Cardiothorac Surg 2013;43(3):591–6.

Wang Z, Zou C, Li D, Li H, Wang A, Yuan G, et al. Surgical Repair of Sinus of Valsalva Aneurysm in Asian Patients. Ann Thorac Surg 2007;84(1):156–60.

Ring WS. Congenital Heart Surgery Nomenclature and Database Project: aortic aneurysm, sinus of Valsalva aneurysm, and aortic dissection. Ann Thorac Surg 2000;69:S147–63.

Lisowski P, Hirnie T, Adamczuk A, Lisowska A, Sobkowicz B, Nadlewski S, et al. Rupture of the sinus of Valsalva aneurysm complicated by infective endocarditis–diagnosis difficulties. Kardiol Pol 2006;64:77–79.

Feldman DN, Gade CL, Roman MJ. Ruptured Aneurysm of the Right Sinus of Valsalva Associated with a Ventricular Septal Defect and an Anomalous Coronary Artery. Tex Heart Inst J 2005;32(4):555–9.

Liu YL, Liu AJ, Ling F, Wang D, Zhu YB, Wang Q, et al. Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm. Ann Thorac Surg 2011;91:542-8.

Moustafa S, Mookadam F, Cooper L, Adam G, Zehr K, Stulak J, et al . Sinus of Valsalva aneurysms – 47 years of a single center experi¬ence and systematic overview of published reports. Am J Cardiol 2007;99:1159–64.

Saito T, Asano M, Ishida M, Sasaki S, Nomura N, Ukai T et al. Ruptured left coronary sinus of valsalva aneurysm into the left ventricle. Ann Thorac Surg 2004;78:2187.

Maruo A, Higami T, Obo H, Shida T. Ruptured sinus of Valsalva aneurysm associated with aortic regurgitation caused by hemodynamic effect solely. Eur J Cardiothorac Surg 2003;24:318 –9.

Valsalva AM: Viri celeberrimi Antonii MariaeValsalvae. Opera 1740.

Ott DA. Aneurysm of the sinus of Valsalva. SeminThorac Cardiovasc Surg Pediatr Card Surg Ann 2006;9:165-76.

Generali T, Garatti A, Biondi A, Varrica A, Menicanti L. Aorta to right atrial shunt due to the rupture of a degenerative aneurysm of the noncoronary sinus of Valsalva. J Cardiovasc Med (Hagerstown). 2013;14(1):71–3.

Kerkar PG, Lanjewar CP, Mishra N, Nyayadhish P, Mammen I. Transcatheter closure of ruptured sinus of Valsalva aneurysm using the Amplatzer duct occluder: immediate results and mid-term follow-up. Eur Heart J 2010;31:2881–7.

Mo A, Lin H, Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique. J Cardiothorac Surg 2010; 5:37.

Yan F, Huo Q, Qiao J, Murat V, Ma SF. Surgery for sinus of Valsalva aneurysm: 27-year experience with 100 patients. Asian CardiovascThorac. Ann 2008;16:361–5.

Zhao G, Seng J, Yan B, Wei H, Qiao C, Zhao S et al. Diagnosis and surgical treatment of ruptured aneurysm in sinus of Valsalva. Chin Med J (Engl) 2003;116:1047–50.

Lin CY, Hong GJ, Lee KC, Tsai YT, Tsai CS. Ruptured congenital sinus of valsalva aneurysms. J Card Surg 2004;19:99–102.

Harkness JR, Fitton TP, Barreiro CJ, Alejo D, Gott VL, Baumgartner WA et al. A 32-year experience with surgical repair of valsalva aneurysms. J Card Surg 2005;20:198–204.

Jung SH, Yun TJ, Im YM, Park JJ, Song H, Lee JW et al. Ruptured sinus of Valsalva aneurysm: transaortic repair may cause sinus of Valsalva distortion and aortic regurgitation. J Thorac Cardiovasc Surg 2008;135: 1153–8.

Guo HW, Sun XG, Xu JP, Xiong H, Wang XQ, Su WJ et al. A new and simple classification for the non-coronary sinus of Valsalva aneurysm. Eur J Cardiothorac Surg 2011;40:1047–51.

Ouali S, Kortas C, Brockmeier K, Boughzela E. Adult aortic coarctation discovered incidentally after the rupture of sinus of Valsalva aneurysm: combined surgical and interventional approach. Interact CardiovascThorac Surg 2011;13(6):688–90.

Tan H, Chen FR. Clinical analysis of 133 patients with ruptured sinus of Valsalva aneurysm. South China J Cardiovasc Dis 2003;9:268–70.

Desai A, Mehta N, Mandurke V, Vichare S, Sonawane A. Left coronary sinus of Valsalva aneurysm ruptured into the left ventricle – Case report. J Indian Coll Cardiol 2013;3(1):32–6.

Akashi H, Tayama E, Tayama K, Kosuga T, Takagi K, Aoyagi S. Remodeling operation for unruptured aneurysms of three sinuses of Valsalva. J Thorac Cardiovasc Surg 2005; 129:951–2.

Hughes GC, Swaminathan M, Wolfe WG. Reimplantation technique (David operation) for multiple sinus of Valsalva aneurysms. Ann Thorac Surg 2006; 82:14 – 6.

Galicia-Tornell MM, Marín-Solís B, Mercado-Astorga O, Espinoza-Anguiano S, Martínez-Martínez M, Villalpando-Mendoza E. Sinus of Valsalva aneurysm with rupture. Case report and literature review. Cir Cir 2009; 77: 441-5.

Morrow AG, Baker RR, Hanson HE, Mattingly TW: Successful surgical repair of a ruptured aneurysm of the sinus of Valsalva. Circulation 1957; 16: 533–8.

Bigelow WG, Barnes WT: Ruptured aneurysm of aortic sinus. Ann Surg 1959; 150: 117–21.

Srivastava A, Radha AS. Case report; transcatheter closure of ruptured sinus of valsalva aneurysm into the left ventricle: a retrograde approach. Pediatr Cardiol 2012;33(2):347-50.

Szkutnik M, Kusa J, Glowacki J, Fiszer R, Bialkowski J. Transcatheter closure of ruptured sinus of valsalva aneurysms with an Amplatzer occluder. Rev Esp Cardiol 2009;62:1317-21.

Work published in KMUJ is licensed under a

 Creative Commons Attribution-NonCommercial 2.0 Generic License.

Creative Commons License

Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.