Extensive Repair Research Articles

From the coast of Kuwait...military BMETs face daunting tasks.

Biomedical Instrumentation & Technology 235 Chief Hospital Corpsman Frank Cabrera is head of biomedical engineering aboard the U.S. Naval Ship, Comfort T-AH 20, a highly-mobile, 1,000-bed surgical platform stationed off the coast of Kuwait. During the recent U.S. military mission in Iraq, Cabrera and his crew were responsible for scheduled and unscheduled maintenance on 3,600 pieces of medical equipment with net assets valued at $4.5 million. Talk about a logistical challenge. Although U.S. ships and soldiers in the field maintained support units in nearby cities or countries, those units were only as good as the supplies that were available. “You can’t just pick up the phone and call for a repair part to be flown out to your location,” said Cabrera, a certified biomedical equipment technician (CBET) and certified radiology equipment specialist (CRES). For BMETs serving in the military, the pressures to perform quick and precise maintenance on medical equipment are magnified by the intensity and unforgiving nature of a wartime setting. And the stakes are high. On the USNS Comfort, for example, 166 coalition casualties, 120 enemy prisoners of war, and 138 civilian casualties were treated, so the ability to restock supplies was vital to everyone involved in the war effort. It normally takes 2 to 3 weeks for a package to be delivered to the ship. Even when an order is placed with the highest priority on the military logistics chain, materials take about 7 days for delivery. So to compensate for shipping delays, Cabrera said the availability of an extensive repair parts inventory was crucial—for both high and low mortality equipment. Cabrera’s advice is to be properly prepared, and prioritize repair-part inventory according to criticality. His inventory aboard the USNS Comfort is vast. It ranges from a GE Pro-speed Computerized Tomography Unit and 4 GE Advantx Legacy Digital X-ray rooms to 2 Philips C-arms and 5 AMX-4 portable X-ray units. He also has 2 Acuson ultrasound machines; Johnson and Johnson Vitros 950 and 250 chemistry analyzer; Coulter ACT DIFF2 coagulation analyzer; 8 blood freezers; and complete surgical services for 14 operating rooms. From the Coast of Kuwait . . .

Radiofrequency incision and lay open technique of pilonidal sinus (clinical practice paper on modified technique).

With the uncertainty as to the etiology and the complexities often encountered in its treatment, a pilonidal sinus has been considered as a tricky disease. Wide varieties of approaches are employed in dealing with this ailment ranging from a conservative treatment to an extensive surgical excision or repair. However, a method of simple lying open of pilonidal sinus is still considered as the favored one. We describe a modified approach to the procedure of incision and lying open the sinus tracts. This retrospective study describes 18 patients of chronic pilonidal sinus treated with a technique of radiofrequency surgery under local anesthesia. There were 12 males and 6 females within an age group ranging from 16 to 30. The patients were subjected to a follow-up for a period of 18 months. The patients were discharged on the same day of the procedure. Mean period off work was 7 days. The average healing time recorded was 67 days. Two wound complications in the form of premature closure of the skin edges were noted, requiring trimming of the edges. One of these two remained unhealed. At the last follow-up, no recurrence was found in the remaining 17 patients. In the era when the emphasis is on the criteria like minimum hospital stay, less postoperative pain, early resumption to work and a reduced recurrence rate, there is a future to the procedure of incision and lying open of the pilonidal sinuses by using the radiofrequency wave.

Differential therapy for the rheumatoid shoulder

Despite frequent involvement, the rheumatoid shoulder is neglected in operative treatment of the upper extremities. The slow course of omarthritis, the compensation mechanism of scapulothoracic motion and neighbouring joints as well as dominating disabilities of the lower extremities and the rheumatoid hand are possible explanations. The pattern of destruction of the rheumatoid shoulder is characterized by progressive joint and soft tissue deterioration. Soft tissue involvement determines the course of the shoulder joint. The subacromial space is a common and early site for rheumatoid involvement, often leading to bursitis, tenosynovitis of the biceps tendon and rotator cuff rupture. Sonography and MRI enable the early detection of subacromial and glenohumeral pathology before deterioration is visible radiologically. Surgical intervention in patients with rheumatoid arthritis of the shoulder is based on the degree of radiological destruction according to Larsen, the natural course of the shoulder joint and the soft-tissue condition. The goals of surgery are to relieve pain, increase motion and restore shoulder function. Surgery should be carried out early in the course of the disease, thus determining the long-term prognosis and the remaining surgical options. Depending on the pattern of destruction of the rheumatoid shoulder, the options for treatment can be divided into early and late procedures.Joint-preserving surgery is indicated in the early stages of radiological destruction according to Larsen classification O-III, whereas the late stages of destruction (Larsen IV-V) require reconstructive surgery. The introduction of arthroscopic and semiarthroscopic techniques has improved the acceptance of early synovectomy for the rheumatoid shoulder, but there is still a place for open synovectomy in patients with extensive soft-tissue repair and bone-remodelling procedures. Arthroscopic and open synovectomy are supplementary and noncompetitive surgical procedures for the rheumatoid shoulder. With proceeding bone and soft-tissue destruction corresponding to Larsen stage IV and V, synovectomy is not successful and reconstructive surgery is necessary. Resection-interposition-arthroplasty (RAIP) remains a controversial alternative to arthroplasty in young patients with sufficient bone stock and a reconstructable rotator cuff. The success of cup-replacement will additionally restrict the indications for RAIP. RIAP remains a possible salvage procedure after aseptic and septic loosening of shoulder arthroplasty. Glenohumeral replacement arthroplasty has become the procedure of choice in reconstructive surgery of the shoulder. The severity of soft-tissue and bone destruction determines the choice of shoulder prosthesis. Current modular shoulder systems with increased numbers of humeral-head stem combinations are calculated to achieve a better adjustment of the soft-tissue tension and to optimize the adaptation between head geometry and the natural shape of the glenoid.The surrounding soft-tissue structure, especially the condition of the rotator cuff, is very important for the functional recovery after shoulder arthroplasty. We prefer a hemiarthroplasty of the rheumatoid shoulder joint to avoid critical glenoid fixation. Patients with irreparable rotator cuff tears and severe glenohumeral arthritis remain a difficult challenge in shoulder surgery and the ideal procedure has not yet been found.Pain relief and a modest increase in active motion are the main goals in operative treatment. Bipolar shoulder arthroplasty represents an adequate alternative to currently favoured hemiarthroplasty in patients with cuff-deficient shoulders.

Discussion: Session 3—Dissection

Discussion: Session 3—Dissection

Parent material and weldments degradation on SASOL reduction reactors due to combined effect of thermal fatigue, vibration and hydrogen attack

All six installed reduction reactors showed the same failure pattern, which can be attributed to inadequate original design, material degradation due to service conditions and improper maintenance activities. Service is typically low frequency fatigue load conditions with changes of pressure, temperature and batch load. All revealed defects severely affected the integrity of the pressure envelope and vessels were classified for major repair work with subsequent in situ monitoring program. The justification for such extensive and costly repair required a positive evaluation of the current condition of equipment. After complete study, a report was prepared which included the fitness for purpose evaluation, remaining life assessment and recommendation for future field inspections. All reactors were found to be suitable for repair. Within the scope of repair a number of critical elements were redesigned and replaced. The repair was successful and all reactors were put back into operation. Unique expertise was obtained regarding setting the parameters of dehydrogenation in reference to the heavy wall items. Taking replicas and surface sampling appeared to be very reliable and simple tools in monitoring the condition of pressure envelope. For the purpose of future inspection shutdowns specific inspection requirements were put in place to ensure continuous monitoring of the vessel integrity.

Extensive primary repair of the thoracic aorta in Stanford type A acute aortic dissection by means of a synthetic vascular graft with a self-expandable stent.

To minimize any residual false lumen when operating on patients with an acute type A aortic dissection, we tried to perform extensive primary repair of the thoracic aorta with the modified elephant trunk technique. The early and midterm results of these surgical interventions are reported and evaluated. Among the acute type A aortic dissections with extensive false lumen encountered since December 1997, 19 consecutive patients, 15 DeBakey type I with the tear in the ascending, transverse, or both aortas, and 4 DeBakey type III-D with the tear located in the descending aorta, underwent insertion of a synthetic graft with a distally anchored stent in the descending thoracic aorta. The interpolation method was used as an introducer combined with total replacement of the aortic arch by using a synthetic branching graft with only a median sternotomy. One patient died, and 18 were discharged after full recovery. Postoperative computed tomographic scans showed that no residual false lumina were present proximal to the diaphragmatic level, and no false lumina were found in 10 patients. Two patients with acute ischemia of the right kidney caused by narrowing of the true lumen, as demonstrated by radiographic computed tomography, improved significantly after surgical intervention with restoration of blood flow in the true lumen. Paraplegia was not observed in any patient. In emergency operations for an acute type A aortic dissection, the operation is often limited to replacing the ascending aorta because priority is given to saving the patient's life. However, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by interpolating a synthetic graft with a self-expandable stent.

Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: Results of a randomized clinical trial

Objective: Despite the use of various strategies for the prevention of spinal cord ischemia, paraplegia and paraparesis continue to occur after thoracoabdominal aortic aneurysm (TAAA) repair. Although cerebrospinal fluid drainage (CSFD) is often used as an adjunct for spinal cord protection, its benefit remains unproven. The purpose of this randomized clinical trial was to evaluate the impact of CSFD on the incidence of spinal cord injury after extensive TAAA repair. Methods: After randomization, 145 patients underwent extent I or II TAAA repairs with a consistent strategy of moderate heparinization, permissive mild hypothermia, left heart bypass, and reattachment of patent critical intercostal arteries. The repairs were performed with CSFD (n = 76) or without CSFD (n = 69). In the former group, CSFD was initiated during the operation and continued for 48 hours after surgery. The target CSF pressure was 10 mm Hg or less. Results: The two groups had similar risk factors for paraplegia. Aortic clamp time, left heart bypass time, and number of reattached intercostal arteries were also similar in both groups. Thirty-day mortality rates were 5.3% (four patients) and 2.9% (two patients) for CSFD and control groups, respectively (P =.68). Nine patients (13.0%) in the control group had paraplegia or paraparesis develop. In contrast, only two patients in the CSFD group (2.6%) had deficits develop (P =.03). No patients with CSFD had immediate paraplegia. Overall, CSFD resulted in an 80% reduction in the relative risk of postoperative deficits. Conclusion: Perioperative CSFD reduces the rate of paraplegia after repair of extent I and II TAAAs. (J Vasc Surg 2002;35;631-9.)

Endovascular Repair of Multiple Peripheral Aneurysms via a Dual Approach Involving a Venous Graft Conduit

Introduction stent across the other sheath, thereby facilitating haemostasis on removal. The profunda femoris origin was The authors report the management of a difficult occluded with Gianturco embolisation coils (Cook U.K. Ltd.) following a satisfactory trial balloon occlusion. surgical problem involving the repair of multiple peripheral aneurysms in a patient with a pre-existing The CFA puncture site was used to sequentially deploy three Wallgraft endoprostheses (nominal size 9 mm synthetic aortic graft in whom autologous long saphenous vein was unavailable. This was carried out long, Boston Scientific Ltd.) within the SFA and venous graft, to exclude the aneurysmal SFA from the cirby an endovascular route through dual access sites, involving uniquely a venous graft conduit. culation. The distal vein graft puncture site was then used to deploy a further Wallgraft (9 mm×70 mm) within the aneurysmal external iliac and CFA. Balloon remodelling at the Wallgraft junctions reduced any Technical Report minor endoleaks. There were no immediate complications and the patient’s feet remained well perfused A 72-year-old man with a history of a coronary artery throughout the procedure. Follow-up arterial duplex bypass graft had previously undergone several surultrasound scans at 3 days, 2 months and 3 months gical procedures for aneurysmal disease including an demonstrated graft patency with aneurysmal exaortic reconstruction with a Dacron aorto-bi-iliac graft, clusion. The patient was discharged home 3 days a right-sided superficial femoral artery (SFA) to belowfollowing the procedure. The cost of four Wallgrafts knee popliteal long saphenous vein bypass graft, and was £3800. a left-sided SFA to peroneal long saphenous vein bypass graft. Since these procedures, however, he presented with multiple aneurysms (1.6–3.6 cm diaDiscussion meter) extending from the left external iliac to the femorodistal graft (Figure 1). The option of extensive surgical repair via a groin The patient underwent endovascular repair of the approach entailing a high risk of morbidity was unaneurysms under local anaesthetic (Figure 2). An antedesirable in this patient. Factors including in-situ syngrade left common femoral artery (CFA) puncture and thetic graft infection and perioperative haemorrhage retrograde distal saphenous vein graft puncture were were also major concerns. Furthermore, the reperformed and accessed with 10 French sheaths. Dual constructed aortic segment and the unavailability of sites were accessed to enable each to deploy a covered both long saphenous veins would clearly complicate a surgical challenge. The use of endovascular covered stents to repair ∗ Please address all correspondence to: R. D. Sayers, Consultant peripheral aneurysms is a relatively new modality. Vascular Surgeon, Department of Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, U.K. Reports have been limited to only small numbers

The “Terrible Triad” of the Elbow

The “Terrible Triad” of the Elbow

An immunohistochemical study of the ‘snowbank’ in a case of pars planitis

Purpose: To characterize the extracellular matrix and cellular components of a ‘snowbank’ removed during vitreous surgery for treatment of retinal detachment complicating pars planitis. Methods: The ‘snowbank’ was examined using immunohistochemical techniques and a panel of monoclonal and polyclonal antibodies directed against glial fibrillary acidic protein (GFAP), cytokeratin, alpha smooth muscle actin, tenascin, laminin, fibronectin, and collagen types I, II, and III. Results: The ‘snowbank’ was acellular except on the uveal side where there were cytokeratin-positive retinal pigment epithelial cells. There were no cells positive for the glial cell marker GFAP and the myofi- broblast cell marker alpha smooth muscle actin. The extracellular matrix of the ‘snowbank’ contained tenascin and collagen types I, II, and III. There was no immunoreactivity for laminin and fibronectin. Conclusion: These results on the immunohistochemical components of the ‘snowbank’ may be useful in clarifying the nature of the chronic inflammatory process in pars planitis. They indicate extensive tissue repair and remodeling, leading to major loss of function.

Erosion Resistance of Arc-Sprayed Coatings to Iron Ore at 25 and 315 °C

Iron ore pellets are sintered and reduced in large continuous industrial oil-fired furnaces. From the furnace, powerful fans extract large volumes of hot gas. Being exposed to gas-borne iron ore particles and temperatures ranging between 125 and 328 °C, fan components are rapidly eroded. Extensive part repair or replacement is required for maintaining a profitable operation. The arc spraying technique has been suggested for repair provided it could produce erosion-resistant coatings. Conventional and cored wires (1.6 mm diameter) were arc sprayed using various spray parameters to produce 250 to 300 µm thick coatings. Arc-sprayed coatings and reference specimens were erosion tested at 25 and 315 °C and impact angles of 25 and 90° in a laboratory gas-blast erosion rig. This device was designed to impact materials with coarse (32 to 300 µm) iron ore particles at a speed of 100 m/s. The coating volume loss due to erosion was measured with a laser profilometer built by National Research Council Canada several years ago.

Melatonin protects against streptozotocin, but not interleukin-1beta-induced damage of rodent pancreatic beta-cells.

In the present study, we examined whether melatonin can protect rodent pancreatic islets against streptozotocin (STZ) and interleukin-1beta (IL-1beta)-induced suppression of beta-cell function. Formation of free radicals, DNA damage and extensive DNA repair leading to depletion of intracellular nicotinamide adenine dinucleotide (NAD) may mediate STZ toxicity. Activation of inducible nitric oxide synthase and nitric oxide (NO) formation may cause IL-1beta -induced beta-cell impairment. We also studied the effect of melatonin against STZ-induced hyperglycemia in C57BL/Ks mice. For in vitro studies, cultured rat islets were exposed to melatonin (100 microM-1 mM) 30 min prior to STZ (0.5 mM) or IL-1beta (25 U/mL) addition. After an additional 30 min incubation with STZ, islet function and NAD content were analyzed either acutely or after 18 hr of recovery in fresh culture medium. For IL-1beta experiments, islets were incubated for 48 hr with the cytokine before evaluation of islet function. We found that melatonin counteracted STZ-induced inhibition of glucose metabolism and insulin release in cultured rat islets after 18 hr of recovery. Moreover, NAD levels were higher in the melatonin-treated group at this time point. Melatonin had no effect on IL-1beta-induced islet inhibition of glucose oxidation or NO formation. Diabetes induced by STZ (140 mg/kg body weight; i.v.) was effectively prevented by administration of melatonin (100 mg/kg body weight; i.p.) 30 min before STZ injection. We conclude that the protective effects of melatonin against beta-cell damage may be related to interference with DNA damage and poly(ADP-ribose) polymerase (PARP) activation rather than through effects on NO generation pathways.

Rapid repair of titanium particle-induced osteolysis is dramatically reduced in aged mice

Aseptic loosening is the most common cause of orthopaedic implant failure. This process is thought to be due to osteolysis induced by implant-derived wear particles. Teitelbaum and colleagues have recently developed a promising murine calvarial model of wear particle-induced osteolysis. However, prior to this study, this model had only been assessed qualitatively. We now report a reproducible, quantitative version of the calvarial model of wear particle-induced osteolysis, in which the extent of osteolysis (and repair) of entire parietal bones is assessed by histomorphometry of contact microradiographs. Using this model, we found that the osteolytic response is transient and rapidly repaired in one month old mice. The extent of osteolysis peaks 7 days after particle implantation and returns to baseline levels by 13 days. A similar amount of osteolysis and even more extensive repair is observed when particles are implanted repeatedly. In contrast, aged mice develop progressive osteolysis with no detectable repair. As a result, 26 month old mice have approximately 17-fold more osteolysis than one month old mice 21 days after particle implantation. Skeletally mature, adult mice (4–16 months old) show an intermediate pattern of response. Osteolysis in these mice peaks at 7 days after particle implantation but it is repaired more slowly than in the one month old mice. Taken together, these results underscore the role of an imbalance between bone resorption and bone formation in the development of aseptic loosening and suggest that agents that stimulate bone formation maybe useful in prevention or treatment of aseptic loosening.

Xeroderma Pigmentosum Group G with Severe Neurological Involvement and Features of Cockayne Syndrome in Infancy

We describe a premature, small for gestational age infant girl with micropthalmia, bilateral congenital cataracts, hearing impairment, progressive somatic and neurodevelopmental arrest, and infantile spasms. She presented a massive photosensitive reaction with erythema and blistering after minimal sun exposure, which slowly gave place to small skin cancers. Her skin fibroblasts were 10-fold more sensitive than normal to UV exposure due to a severe deficiency in nucleotide excision repair. By complementation analysis, the patient XPCS4RO was assigned to the very rare xeroderma pigmentosum (XP) group G (XP-G). One allele of her XPG gene contained a 526C-->T transition that changed Gln-176 to a premature UAG stop codon. Only a minor fraction of XPG mRNA was encoded by this allele. The second, more significantly expressed XPG allele contained a 215C-->A transversion. This changed the highly conserved Pro-72 to a histidine, a substitution that would be expected to seriously impair the 3' endonuclease function of XPG in nucleotide excision repair. In cases suspected of having XP and/or early-onset Cockayne syndrome, extensive DNA repair studies should be performed to reach a correct diagnosis, thereby allowing reliable genetic counseling and prenatal diagnosis.

Improvements in modeling and evaluation of electrical power system reliability

This paper describes updates in an electrical reliability modeling process, first described in a 1993 paper for the Petroleum and Chemical Industry Committee of the IEEE Industry Applications Society. The paper also describes an additional new method for evaluating power system design options. The electrical reliability model has been expanded with more extensive component failure and repair values. Additional modeling techniques have been developed for evaluating typical electrical systems found in petroleum and chemical facilities. The reliability calculation results, based on the actual modeling of many refineries in the US, are described. The paper also describes a new method which was developed to evaluate and compare power system designs, based on the resulting composite reliability values and other factors, including recovery from faults, availability for maintenance, safety and cost. This new method provides an analytical approach to optimize the power system design to the plant operation and maintenance requirements.

Imiquimod: a novel treatment for lentigo maligna

Lentigo maligna is the in situ phase of lentigo maligna melanoma, and if left untreated it may progress to invasive melanoma. It most commonly occurs on the exposed sites of the face and neck of middle-aged or elderly patients. Conventional surgery using a 5-10 mm margin is the recommended treatment; however, lesions can be quite large and surgical removal may involve extensive plastic repair. We report an elderly patient with a large lentigo maligna on the scalp who was reluctant to have surgery. We tried topical imiquimod 5% cream (Aldara), a local immunomodulator, which has recently become available for the treatment of external genital and perianal warts. Initially used over a test area and then over the whole of the lesion, for a total of 7 months, the imiquimod cream resulted in complete clinical and histological cure. The patient has been followed up for 9 months without evidence of recurrence.

INDUCTION OF OXIDATIVE DNA DAMAGE IN U937 CELLS BY TNF OR ANTI-FAS STIMULATION

TNF and Fas signaling pathways are reported to induce mitochondrial damage associated with production of oxygen radicals. We examined whether such radical production elicited detectable nuclear DNA damage in U937 cells following treatment with TNF or with anti-Fas antibodies. Using GC-mass spectroscopy for analysing base oxidation, several oxidized species increased significantly following TNF treatment, whereas anti-Fas resulted in less detectable oxidative damage using this assay. Cytogenetic analysis showed that, in the presence of aphidicolin, which blocks several types of DNA repair, TNF induced extensive chromosomal damage. Aphidicolin also synergized with TNF and anti-Fas in inducing cell death which was prevented by reducing atmospheric oxygen or addition of n -acetyl cysteine, a scavenger of oxygen radicals. Thus, several lines of evidence point to the TNF and Fas pathways inducing extensive oxidative DNA damage and repair, and suggest potential roles for these pathways in mutagenesis and aging.

Resistance to gap repair of the transposon Tam3 in Antirrhinum majus: a role of the end regions.

The extremely homogeneous organization of the transposon family Tam3 in Antirrhinum majus is in sharp contrast to the heterogeneity of the copies constituting many other transposon families. To address the issue of the Tam3 structural uniformity, we examined two possibilities: (1) recent invasion of Tam3 and (2) failure of gap repair, which is involved in conversion from autonomous forms to defective forms. The phylogenetic analysis of 17 Tam3 copies suggested that the invasion of Tam3 into the Antirrhinum genome occurred at least 5 mya, which is sufficiently long ago to have produced many aberrant copies by gap repair. Thus, we investigated gap repair events at the nivea(recurrens:Tam3) (niv(rec)::Tam3) allele, where Tam3 is actively excised. We show here that the gap repair of de novo somatic Tam3 excision was arrested immediately after initiation of the process. All of the identified gap repair products were short stretches, no longer than 150 bp from the ends. The Tam3 ends have hairpin structures with low free energies. We observed that the gap repair halted within the hairpin structure regions. Such small gap repair products appear to be distributed in the Antirrhinum genome, but are unlikely to be active. Our data strongly suggest that the structural homogeneity of Tam3 was caused by immunity to gap repair at the hairpins in both of the end regions. The frequency of extensive gap repair of de novo excision products in eukaryotic transposons was found to be correlated with the free energies of the secondary structures in the end regions. This fact suggests that the fates of transposon families might depend on the structures of their ends.

The ac superposition method, a new hot-line diagnostic method for 6-kV XLPE power cables

Water trees are the most hazardous factor affecting the life of XLPE distribution cables and the major cause of insulation failure. It is well known that insulation failure causes stoppages in electrical service and requires extensive repair work. Up to now, deterioration of cable insulation has been diagnosed mainly by the dc leakage current method. However, application of this method for diagnostic measurements requires interruption of electrical service. Several types of hot-line diagnostic methods (including the dc component current and dc superposition methods) were developed to detect water tree deterioration. However, these methods have some shortcomings, such as being subject to effects of stray currents and the accuracy of measurements not being sufficiently high. Therefore, we have attempted to develop a new hot-line diagnostic method. We investigated whether the signals produced by superposition of voltages of various frequencies to the cover layer of energized cables were correlated with deterioration by the water treeing. As a result, we found that a deterioration signal of 1 Hz was observed when we superposed an ac voltage (commercial frequency × 2 +1 Hz) on the cover layer of cable where the water tree had occurred in the insulation. © 1999 Scripta Technica, Electr Eng Jpn, 130(2): 49–58, 2000

Sinus of valsalva aneurysm or fistula: management and outcome

Background. Few large or long-term series exist regarding the management of patients with sinus of Valsalva aneurysms or fistulas (SVAFs).Methods. Between 1956 and 1997, 129 patients presented with a ruptured (64 cases; 49.6%) or nonruptured (65 cases; 50.4%) SVAF. The patients included 88 men and 41 women, with a mean age of 39.1 years. Associated findings included a history of endocarditis (42 cases; 32.6%), a bicuspid aortic valve (21 cases; 16.3%), a ventricular septal defect (15 cases; 11.6%), and Marfan’s syndrome (12 cases; 9.3%). Operative procedures included simple plication (61 cases; 47.3%), patch repair (52 cases; 40.3%), aortic root replacement (16 cases; 12.4%), and aortic valve replacement/repair (75 cases; 58.1%).Results. There were five in-hospital deaths (3.9%): four due to preexisting sepsis and endocarditis and one that followed dehiscence of the repair in a patient with Marfan’s syndrome. Two patients (1.6%) had strokes during the early postoperative period. The survivors were followed up for 661.1 patient-years (5.3 years/patient). The following late complications occurred: prosthetic valve malfunction (5 cases; 3.9%), prosthetic valve endocarditis (3 cases; 2.3%), SVAF recurrence (2 cases; 1.6%), thrombosis (1 case; 0.8%), and anticoagulation-related bleeding (1 case; 0.8%).Conclusions. Resection and repair of SVAF entails an acceptably low operative risk and yields long-term freedom from symptoms. Early, aggressive treatment is recommended to prevent endocarditis or lesional enlargement, which causes worse symptoms and necessitates more extensive repair.