Surgical Treatment of Ruptured Aneurysms of the Sinus of Valsalva*

Abstract

Aneurysms of the sinus of Valsalva are usu- ally congenital in origin. When they rupture, it is generally into the right atrium or the right ventricle. Signs of a left- to-right shunt, aortic runoff, and cardiac decompensation are the cardinal features. Early diagnosis and surgical cor- rection result in cure. We report our experience with 28 patients. In all patients, we used a combined aortocameral approach, and we recommend a sandwich patch for the repair. Aortic valve replacement is needed only in patients with severe degenerative changes. The overall operative mortality was 21.4%, but in the last 10 years, mortality was only 11.7%. The causes of operative and late mortality are discussed. Ruptured aneurysms of the sinus of Valsalva represent a form of arteriovenous communication that is challenging to the surgeon and potentially lethal for the patient. Sur- gical closure of the fistula offers the only form of perma- nent cure. Although ruptured aneurysms of the sinus of Valsalva may be congenital or acquired in origin, most of them are the result of a congenital defect. Edwards and Bur- chell (l) attributed the congenital variety to a discon- tinuity between the aortic media and the annulus fibrosis of the aortic valve. The coexistence of a ventricu- lar septa1 defect (VSD) in a significant percentage of pa- tients with this malformation further substantiates the congenital nature of the condition.