Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm

Jacques A M Van Son, Gordon K. Danielson, Hartzell V Schaff, Thomas A. Orszulak, William D. Edwards, James B. Seward

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Background: Because not much is known about the long-term results of surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA), we reviewed our entire 37-year experience with this condition. Methods and Results: From August 1956 through September 1993, 31 patients aged 3 to 54 years (median age, 29 years) underwent surgical correction of RSVA. Aneurysms originated in the right (n=24) and noncoronary (n=7) sinuses and entered the right ventricle in 21 patients and the right atrium in 10. Coexistent cardiac lesions included ventricular septal defect (VSD) (n=16, 15 of which were subarterial) and aortic valve insufficiency (n=13). There was a highly significant correlation between aortic insufficiency and the presence of an associated subarterial VSD (P<.0001). There was no hospital mortality. One patient (3.2%) died of endocarditis 9 years after subsequent aortic valve replacement; overall survival was 95% at 20 years. Two foreign patients were lost to follow-up after 11 and 13 years, respectively. Follow-up in the remaining 28 survivors extended to 37 years (mean, 25.7 years). Five patients (16.1%) underwent reoperation for aortic valve replacement (n=3), closure of recurrent fistula (n=1), and closure of both recurrent fistula and recurrent VSD (n=1); all had their primary operation before 1976. All patients who had reoperation had right sinus of Valsalva-to-right ventricle fistulas, and 4 had an additional subarterial VSD. Risk of reoperation was higher with right ventricle fistulas than with right atrium fistulas, and this approached statistical significance (P=.06). Risk of reoperation in patients with right ventricle fistulas was lower when an aortotomy (with or without right ventriculotomy) was used during repair (1 of 8, 12.5%) versus right ventriculotomy only (4 of 13, 30.8%), although this did not reach statistical significance (P=.10). Need for reoperation was increased with the presence of a subarterial VSD (P=.08) but not with location of fistula or type of repair (direct suture versus patch). Of 9 patients with mild aortic insufficiency at primary operation, two developed late severe aortic insufficiency necessitating aortic valve replacement at 21 and 31 years, respectively. Twenty-five patients are in New York Heart Association class I, and 3 are in class II. Conclusions: Long-term survival after surgical treatment of RSVA is excellent. The risk for recurrent fistula or VSD is minimal in the current era. Late aortic insufficiency is still a risk, especially in right sinus of Valsalva-to-right ventricle fistula with associated subarterial VSD. Repair of RSVA through an aortotomy with or without cardiotomy permits inspection of the aortic root complex and facilitates aortic valve repair; this approach may reduce the incidence of late aortic insufficiency.

Original languageEnglish (US)
JournalCirculation
Volume90
Issue number5 II
StatePublished - Nov 1994

Fingerprint

Sinus of Valsalva
Fistula
Aneurysm
Ventricular Heart Septal Defects
Reoperation
Heart Ventricles
Aortic Valve
Aortic Valve Insufficiency
Patient Rights
Heart Atria
Survival
Lost to Follow-Up
Hospital Mortality
Endocarditis
Sutures
Survivors

Keywords

  • aortic sinus fistula
  • aortic valve insufficiency
  • congenital heart surgery
  • sinus of Valsalva aneurysm

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Van Son, J. A. M., Danielson, G. K., Schaff, H. V., Orszulak, T. A., Edwards, W. D., & Seward, J. B. (1994). Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. Circulation, 90(5 II).

Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. / Van Son, Jacques A M; Danielson, Gordon K.; Schaff, Hartzell V; Orszulak, Thomas A.; Edwards, William D.; Seward, James B.

In: Circulation, Vol. 90, No. 5 II, 11.1994.

Research output: Contribution to journalArticle

Van Son, JAM, Danielson, GK, Schaff, HV, Orszulak, TA, Edwards, WD & Seward, JB 1994, 'Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm', Circulation, vol. 90, no. 5 II.
Van Son JAM, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB. Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. Circulation. 1994 Nov;90(5 II).
Van Son, Jacques A M ; Danielson, Gordon K. ; Schaff, Hartzell V ; Orszulak, Thomas A. ; Edwards, William D. ; Seward, James B. / Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. In: Circulation. 1994 ; Vol. 90, No. 5 II.
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abstract = "Background: Because not much is known about the long-term results of surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA), we reviewed our entire 37-year experience with this condition. Methods and Results: From August 1956 through September 1993, 31 patients aged 3 to 54 years (median age, 29 years) underwent surgical correction of RSVA. Aneurysms originated in the right (n=24) and noncoronary (n=7) sinuses and entered the right ventricle in 21 patients and the right atrium in 10. Coexistent cardiac lesions included ventricular septal defect (VSD) (n=16, 15 of which were subarterial) and aortic valve insufficiency (n=13). There was a highly significant correlation between aortic insufficiency and the presence of an associated subarterial VSD (P<.0001). There was no hospital mortality. One patient (3.2{\%}) died of endocarditis 9 years after subsequent aortic valve replacement; overall survival was 95{\%} at 20 years. Two foreign patients were lost to follow-up after 11 and 13 years, respectively. Follow-up in the remaining 28 survivors extended to 37 years (mean, 25.7 years). Five patients (16.1{\%}) underwent reoperation for aortic valve replacement (n=3), closure of recurrent fistula (n=1), and closure of both recurrent fistula and recurrent VSD (n=1); all had their primary operation before 1976. All patients who had reoperation had right sinus of Valsalva-to-right ventricle fistulas, and 4 had an additional subarterial VSD. Risk of reoperation was higher with right ventricle fistulas than with right atrium fistulas, and this approached statistical significance (P=.06). Risk of reoperation in patients with right ventricle fistulas was lower when an aortotomy (with or without right ventriculotomy) was used during repair (1 of 8, 12.5{\%}) versus right ventriculotomy only (4 of 13, 30.8{\%}), although this did not reach statistical significance (P=.10). Need for reoperation was increased with the presence of a subarterial VSD (P=.08) but not with location of fistula or type of repair (direct suture versus patch). Of 9 patients with mild aortic insufficiency at primary operation, two developed late severe aortic insufficiency necessitating aortic valve replacement at 21 and 31 years, respectively. Twenty-five patients are in New York Heart Association class I, and 3 are in class II. Conclusions: Long-term survival after surgical treatment of RSVA is excellent. The risk for recurrent fistula or VSD is minimal in the current era. Late aortic insufficiency is still a risk, especially in right sinus of Valsalva-to-right ventricle fistula with associated subarterial VSD. Repair of RSVA through an aortotomy with or without cardiotomy permits inspection of the aortic root complex and facilitates aortic valve repair; this approach may reduce the incidence of late aortic insufficiency.",
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AU - Van Son, Jacques A M

AU - Danielson, Gordon K.

AU - Schaff, Hartzell V

AU - Orszulak, Thomas A.

AU - Edwards, William D.

AU - Seward, James B.

PY - 1994/11

Y1 - 1994/11

N2 - Background: Because not much is known about the long-term results of surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA), we reviewed our entire 37-year experience with this condition. Methods and Results: From August 1956 through September 1993, 31 patients aged 3 to 54 years (median age, 29 years) underwent surgical correction of RSVA. Aneurysms originated in the right (n=24) and noncoronary (n=7) sinuses and entered the right ventricle in 21 patients and the right atrium in 10. Coexistent cardiac lesions included ventricular septal defect (VSD) (n=16, 15 of which were subarterial) and aortic valve insufficiency (n=13). There was a highly significant correlation between aortic insufficiency and the presence of an associated subarterial VSD (P<.0001). There was no hospital mortality. One patient (3.2%) died of endocarditis 9 years after subsequent aortic valve replacement; overall survival was 95% at 20 years. Two foreign patients were lost to follow-up after 11 and 13 years, respectively. Follow-up in the remaining 28 survivors extended to 37 years (mean, 25.7 years). Five patients (16.1%) underwent reoperation for aortic valve replacement (n=3), closure of recurrent fistula (n=1), and closure of both recurrent fistula and recurrent VSD (n=1); all had their primary operation before 1976. All patients who had reoperation had right sinus of Valsalva-to-right ventricle fistulas, and 4 had an additional subarterial VSD. Risk of reoperation was higher with right ventricle fistulas than with right atrium fistulas, and this approached statistical significance (P=.06). Risk of reoperation in patients with right ventricle fistulas was lower when an aortotomy (with or without right ventriculotomy) was used during repair (1 of 8, 12.5%) versus right ventriculotomy only (4 of 13, 30.8%), although this did not reach statistical significance (P=.10). Need for reoperation was increased with the presence of a subarterial VSD (P=.08) but not with location of fistula or type of repair (direct suture versus patch). Of 9 patients with mild aortic insufficiency at primary operation, two developed late severe aortic insufficiency necessitating aortic valve replacement at 21 and 31 years, respectively. Twenty-five patients are in New York Heart Association class I, and 3 are in class II. Conclusions: Long-term survival after surgical treatment of RSVA is excellent. The risk for recurrent fistula or VSD is minimal in the current era. Late aortic insufficiency is still a risk, especially in right sinus of Valsalva-to-right ventricle fistula with associated subarterial VSD. Repair of RSVA through an aortotomy with or without cardiotomy permits inspection of the aortic root complex and facilitates aortic valve repair; this approach may reduce the incidence of late aortic insufficiency.

AB - Background: Because not much is known about the long-term results of surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA), we reviewed our entire 37-year experience with this condition. Methods and Results: From August 1956 through September 1993, 31 patients aged 3 to 54 years (median age, 29 years) underwent surgical correction of RSVA. Aneurysms originated in the right (n=24) and noncoronary (n=7) sinuses and entered the right ventricle in 21 patients and the right atrium in 10. Coexistent cardiac lesions included ventricular septal defect (VSD) (n=16, 15 of which were subarterial) and aortic valve insufficiency (n=13). There was a highly significant correlation between aortic insufficiency and the presence of an associated subarterial VSD (P<.0001). There was no hospital mortality. One patient (3.2%) died of endocarditis 9 years after subsequent aortic valve replacement; overall survival was 95% at 20 years. Two foreign patients were lost to follow-up after 11 and 13 years, respectively. Follow-up in the remaining 28 survivors extended to 37 years (mean, 25.7 years). Five patients (16.1%) underwent reoperation for aortic valve replacement (n=3), closure of recurrent fistula (n=1), and closure of both recurrent fistula and recurrent VSD (n=1); all had their primary operation before 1976. All patients who had reoperation had right sinus of Valsalva-to-right ventricle fistulas, and 4 had an additional subarterial VSD. Risk of reoperation was higher with right ventricle fistulas than with right atrium fistulas, and this approached statistical significance (P=.06). Risk of reoperation in patients with right ventricle fistulas was lower when an aortotomy (with or without right ventriculotomy) was used during repair (1 of 8, 12.5%) versus right ventriculotomy only (4 of 13, 30.8%), although this did not reach statistical significance (P=.10). Need for reoperation was increased with the presence of a subarterial VSD (P=.08) but not with location of fistula or type of repair (direct suture versus patch). Of 9 patients with mild aortic insufficiency at primary operation, two developed late severe aortic insufficiency necessitating aortic valve replacement at 21 and 31 years, respectively. Twenty-five patients are in New York Heart Association class I, and 3 are in class II. Conclusions: Long-term survival after surgical treatment of RSVA is excellent. The risk for recurrent fistula or VSD is minimal in the current era. Late aortic insufficiency is still a risk, especially in right sinus of Valsalva-to-right ventricle fistula with associated subarterial VSD. Repair of RSVA through an aortotomy with or without cardiotomy permits inspection of the aortic root complex and facilitates aortic valve repair; this approach may reduce the incidence of late aortic insufficiency.

KW - aortic sinus fistula

KW - aortic valve insufficiency

KW - congenital heart surgery

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