• Journal of Chest Surgery
• /
• v.12 no.1
• /
• pp.43-49
• /
• 1979

This is a case report of surgically treated rupture of Valsalva Sinus aneurysm combined with VSD. He has been relatively healthy until about one month before admission, when during bath, he felt abruptly palpitation, left chest pain and exertional dyspnea. These symptoms have progressed. On admission, thrill was palpable and continuous machinery murmur was audible on 2nd and 3rd intercostal space along the left sternal border. A rupture of Valsalva`s sinus aneurysm was confirmed by aortography and echocardiography but a small VSD was found by cardiotomy in open heart surgery. On 11th Sep. 1978, open heart surgery was performed. Valsalva`s sinus aneurysm came out from right coronary aortic sinus and ruptured into the right ventricle. It sized 1.2X1.5X1.5 cm. Ruptured opening was noted on apex of aneurysm [0.8X0.8cm], VSD [1. 0X0. 3cm in size] was just below the aortic annulus. The aneurysmal sac was removed on neck. After that, VSD and aneurysmal orifice were closed together with interrupted mattress sutures on same plane. The postoperative course was uneventful and discharged three weeks after open heart surgery.

• Journal of Chest Surgery
• /
• v.22 no.5
• /
• pp.748-752
• /
• 1989

We experienced 6 patients with the sinus Valsalva aneurysm rupture during last 12 years [Jan. 1977-Sep. 1989]. Of them. 5 cases were reviewed. They consist of 3 males and 2 females, and the age ranged from 12 years to 40 years with the mean age of 25 years. 4 patients showed congestive heart failure symptoms. The diagnosis was made by 2D-Echo and cine-angiogram. In 4 patients. sinus Valsalva aneurysm ruptured from the Rt. coronary sinus to the Rt. ventricle, and in one from non-coronary sinus to the Rt. atrium. In 2 cases, resection of the aneurysm and simple stitch closure was made. Resection of the aneurysm k patch closure and AVR in one, closure of the fistula, AVR and patch closure of the associated VSD in one, and closure of the fistula, AVR k TVR in one were made in another 3 cases. There was no postoperative mortality case.

• Journal of Chest Surgery
• /
• v.31 no.3
• /
• pp.304-307
• /
• 1998

Aneurysm of the sinus of Valsalva on mostly congenital disease that develops more frequently in Orientals, is very low in incidence. In most cases, aneurysm of the sinus of Valsalva extends to intracardiac and results in ruptures into the right ventricle or atrium. The likelihood of extracardiac aneurysm of the sinus of Valsalva is very low. Cases of extracardiac aneurysm are usually accompanied by aortic regurgitation and can cause right ventricle outflow tract obstruction, myocardial ischemia, and myocardial infarction due to compression by aneurysm. Since the aneurysm can rupture in the intrapericardium and cause cardiogenic shock or sudden death, definite diagnosis and management are important. If confirmed, it is preferable operform a surgical correction. We report here, with a literature review, a case where myocardial ischemia and aortic egurgitation caused by aneurysm developed in the left coronary and noncoronary sinus, and were surgically corrected with satisfactory esults.

• Journal of Chest Surgery
• /
• v.15 no.1
• /
• pp.124-128
• /
• 1982

Here, we present a case of ruptured sinus Valsalva aneurysm with fistulous communication between the right coronary aortic sinus and the right ventricle in 8 year old boy. Ruptured sinus Valsalva aneurysm is rare. And several reports are describing its pathophysiologic features, clinical findings and management. This patient was asymptomatic and the physical examination revealed palpable thrill and Grade III pansystolic murmur at the 3rd and 4th intercostal space along the left sternal border. There was an oxygen step up from right atrium into right ventricle on the cardiac catheterization reports. On 15th July 1981, an open heart surgery was performed and we found ruptured right coronary sinus Valsalva aneurysm into the right ventricle, which was managed successfully by doing direct pledget sutures. The postoperative course was uneventful.

• Journal of Chest Surgery
• /
• v.18 no.2
• /
• pp.265-272
• /
• 1985

Congenital aneurysm of sinus of Valsalva is one of the rare congenital heart disease, which is usually asymptomatic until rupture. The aneurysm usually ruptures into a cardiac chamber and produces an aorto-intracardiac fistula. Ruptured aneurysm is a grave lesion in that it causes heart failure and subsequent death. If, however, it is discovered in its early stages and operated on properly, it can be corrected with considerable success. Form January 1975 through December 1984, 18 consecutive patients with congenital aneurysm of sinus of Valsalva underwent corrective surgery using total cardiopulmonary bypass in our department of Thoracic Surgery. 1. The incidence was about 0.9% of surgical cases of congenital heart disease during that period. 2. 13 were males and 5 females, with ages ranging 12 years to 52 years. 3. Associated anomalies were VSD in 14, infundibular PS in 1, aberrant muscle band in RVOT in 1, and secondary aortic insufficiency in 9. 4. 17 were suggested to arise from right coronary sinus and 1 from noncoronary sinus; Among 17, 12 ruptured into right ventricle, and one from noncoronary sinus into right atrium. 5. Surgical correction was performed by means of direct suture closure with combined pledget or patch graft after aneurysm resection, and associated lesions were also corrected simultaneously. 6. There was only one case of operative mortality, and all the other patients were relatively uneventful in their follow-up studies.

• Journal of Chest Surgery
• /
• v.22 no.4
• /
• pp.687-692
• /
• 1989

Aneurysm of the sinus of Valsalva is an uncommon cardiac anomaly, usually congenital in origin, which may occur as an isolated defect or in conjunction with other cardiac malformation. This report is a case of a ruptured sinus of Valsalva aneurysm with ventricular septal defect in a 18-year-old female patient who complained progressive exertional dyspnea. She underwent operative management using total cardiopulmonary bypass. The fistula originated from the right coronary sinus and ruptured into the right ventricle and coexistent lesion was supracristal ventricular septal defect. The repair was done through aortic and right ventricular approach. The ruptured sinus of Valsalva was closed with pledget suture and the ventricular septal defect was closed with patch. The postoperative result was good.

• Journal of Chest Surgery
• /
• v.37 no.7
• /
• pp.578-584
• /
• 2004

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.

• Journal of Chest Surgery
• /
• v.26 no.6
• /
• pp.488-491
• /
• 1993

Over the past 8 years, from 1985 to 1992, 6 patients with ruptured aneurysm of the sinus of Valsalva underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. Five aneurysms originated from the right coronary sinus and ruptured into right ventricle and one from noncoronary sinus into RA. Ventricular septal defects were associated with 5 cases and one had no associated cardiac anomalies. The ruptured aneurysms were repaired through double incisions in 3 cases, through aortotomy in 2 cases and through right atriotomy in 1 case. There were no early and late complications and follow up results are excellent in all patients.

• Journal of Chest Surgery
• /
• v.32 no.7
• /
• pp.665-667
• /
• 1999

We report a case of ruptured sinus of Valsalva aneurysm in 48-year-old male, presenting the symptom of congestive heart failure. Echocardiography showing a hairpin-like sac ex tended from the left coronary sinus to the left ventricle adjacent to the anterior mitral valve leaflet, suggested ruptured sinus of Valsalva aneurysm or aorto-left ventricular tunnel. Operative findings revealed that left sinus of Valsalva aneurysm had multiple openings faced left ventricle, 7 mm in diameter, 20 mm in length. The proximal opening was closed with bovine pericardium and distal openings were closed with spaghetti pledgeted reinforced sutures. The patient was discharged on the 14th postoperative day, and follow up for 8 months uneventfully. This case was reported for its rarity and to describe the techniques of surgical repair.

• Journal of Chest Surgery
• /
• v.38 no.10 s.255
• /
• pp.693-698
• /
• 2005

Background: Sinus valsalva aneurysm (SVA) is a rare disease, and it is frequently accompanied by ventricular septal defect and aortic valve regurgitaion. For treatment of SVA, several surgical mordalities were applied, but there was no report on the long-term result after surgical repair in Korea. We reviewed our 28 years of experiences and analyzed the long-term results after treatment of sinus valsalva aneurysm with or without rupture. Material and Method: Between March 1974 and February 2002, 81 patients were operated under the impression of sinus valvsalva aneurysm or sinus valsalva aneurym rupture. Retrospectively we reviewed the patients' record. Mean age of patients was $29.2\pm11.5$ and there were 49 males. Accompanyng diseases were as follows: VSD in 50, PDA in 2, Behcet's disease in 2, TOF in 1, RVOTO in 1, AAE in 1. Seventy-seven $(95\%)$ patients had sinus valsalva rupture and in 14 patients, subacute bacterial endocarditis was accompanied. Degree of aortic valve regurgitation was as follows: grade I: 8, II: 10, III: 9, IV: 4. Most common rupture site was right coronary sinus (66 patients, $81\%$) and most common communication site was right ventricle (53 patients). In repair of sinus valsalva rupture, patch was used in 37 patients, and direct suture was done in 38 patients. Result: There was one surgical death $(1.2\%)$. Follow up was done in 78 patients $(97.5\%)$, mean follow up period was $123.3\pm80.9(3\~330\;months)$. During the follow up period, 3 patients died $(3.8\%)$. One patient died of heart failure, another patient died of arrhythmia and the other one died of unknown cause. In two patients, complete atrio-ventricular block was developed during follow up period, and there was no operation related event or complication. Kaplan-Meier survival analysis revealed $92.5\pm3.5\%$ survival at 15 and 27 years and it seems to be satisfactory. Conclusion: Long-term surgical results and survival is satisfactory after repair of sinus valsalva aneurysm with or without rupture.