Aortic Sinus Fistula—Surgical Considerations and Results of Operation

Abstract

From 1956 to 1971, 21 Mayo Clinic patients underwent surgical correction of aortic sinus fistula. The 12 male and 9 female patients were from 3 to 52 years old (median 27 years). In 16 patients the right aortic sinus had ruptured into the right ventricle, and in 1, into the right atrium; in 4 patients a noncoronary sinus fistula communicated with the right atrium. The appearance of 4 fistulas was related to trauma, but all 21 fistulas were basically congenital in origin. Associated lesions were common; 15 patients had one or more of the following: ventricular septal defect (VSD) (14 patients), aortic insufficiency (7 patients), and pulmonary stenosis (3 patients). All patients survived operation. Three required reoperation: 1 for closure of a recurrent VSD (deterioration of an Ivalon sponge patch), 1 for recurrence of the fistula and VSD, and 1 to replace a malfunctioning Teflon cusp with a prosthetic valve. Follow-up has been carried out for as long as fourteen years (median seven years) after operation. One patient has moderate aortic insufficiency but remains well compensated; the remaining patients are free of symptoms and clinical signs of cardiac dysfunction. Currently, an aortic sinus fistula should be repaired when it is diagnosed because the disability is progressive, operative risk is negligible, and long-term results are excellent.