Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique

Ansheng Mo,Hui Lin

doi:10.1186/1749-8090-5-37

Abstract

BackgroundRupture of aneurysms of the sinus of Valsalva results in abrupt onset of congestive heart failure. On-pump beating-heart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Herein, we report the operative correction of thirty-one patients of ruptured aneurysms of the sinus of Valsalva, using the on-pump beating-heart technique.MethodsThirty-one patients with ruptured aneurysms of the sinus of Valsalva underwent operative corrections using the on-pump beating-heart technique. In patients with fistula diameter less than 1 cm and no aortic regurgitation, the aorta was unclamped throughout cardiopulmonary bypass(CPB) while receiving antegrade heart perfusion. In remainder of patients, retrograde perfusion was used.ResultsAfter intracardiac manipulation was complete and the nasopharyngeal temperature was raised to 36-37°C, the patients were smoothly weaned off CPB. There were no early or late postoperative deaths. All patients were in New York Heart Association functional class I at follow-up (range, 0.5-1 year). Mild-to-moderate aortic valve regurgitation was observed in one patient. No recurrence of the left-to-right shunt from ruptured aneurysms of the sinus of Valsalva was observed.ConclusionsBeating heart on pump allows adequate examination of the aortic lesion under near-physiologic conditions, allows decrease in ischemia-reperfusion injury and potentially decreases the risk of serious or fatal rhythm disturbances. On-pump beating-heart technique for repair of ruptured aneurysm of sinus of Valsalva is feasible and promising. Antegrade heart perfusion is suitable for patients with a fistula diameter <1 cm and no aortic regurgitation, and retrograde perfusion is suitable for the others.

Highlights

Rupture aneurysms of the sinus of Valsalva usually results in abrupt onset of congestive heart failure
Based on our previous reports [19], we have further introduced on-pump beating-heart technique for correction of ruptured aneurysms of sinus of Valsalva, and have determined the optimal heart perfusion for different situations
All patients were in New York Heart Association (NYHA) functional class I at late follow-up

Summary

Introduction

Rupture of aneurysms of the sinus of Valsalva results in abrupt onset of congestive heart failure. We report the operative correction of thirty-one patients of ruptured aneurysms of the sinus of Valsalva, using the on-pump beating-heart technique. Rupture aneurysms of the sinus of Valsalva usually results in abrupt onset of congestive heart failure. Repair of intracardiac teratosis is always performed under cardioplegic arrest This might cause cardiac impairment leading to low postoperative cardiac output [1,2,3,4,5,6,7,8,9,10,11,12]. Evidence from experimental and clinical work has demonstrated that on-pump beating-heart surgery reduces further cardiac impairment by maintain-. Based on our previous reports [19], we have further introduced on-pump beating-heart technique for correction of ruptured aneurysms of sinus of Valsalva, and have determined the optimal heart perfusion for different situations

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Results

Conclusion