Surgery for sinus of Valsalva aneurysm： 33-year of a single center experience

Background Sinus of Valsalva aneurysm （SVA） is a rare anomaly and few large or long-term series are well established.This study was designed to review 33-year surgical experience of SVA in one center.Methods From August 1980 to December 2013,patients with SVA underwent surgical repair were retrospectively studied.Results A total of 160 patients were identified with mean age of （30±12） years and 112 （70％） of them were males.The right coronary sinus origin of SVA was found in 108 patients （67.5％）,the non-coronary sinus in 51 patients （31.9％）,and the left coronary sinus in one patient （0.6％）.The rupture of 3VA into the right ventricle was identified in 89 （55.6％） cases,the right atrium in 61 （38.1％）,the left ventricle in 2 （1.3％） and no rupture in 8 （5.0％）.Ventricular septal defect （VSD） and aortic regurgitation （AR） were found in 59 （37％） and 45 （28％） patients respectively.An approach via the involved chamber was used in 86 patients （54％）,aortotomy in 8 （5％）,and a combined approach in 66 （41％）.Either direct suture （56,35％） or patch （104,65％） closure were used to repair the SVA.The VSD was closed with a patch （44/59,75％） or direct suture （15/59,25％）.aortic valve replacement （AVR） was performed in 23/45 （51％） and aortic valvuloplasty （AVP） in 9/45 （20％） patients combined with AR.There were 3 hospital deaths （1.9％） and 2 late deaths and 84％ of the patients were followed up for （17.6±4.2） years.New York Heart Association functional class improved significantly after surgery （P＜0.01）.Actuarial survival was 94％ at 10 years,and 88％ at 20 years.Conclusions Surgical treatment of SVA is safe and effective,ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as possible.However,late progressive AR is still a risk during long-term follow-up,and early aggressive measures are recommended.These include more use of a combined approach to achieve optimal evaluation of lesions,more patch repairs to reduce the chance of recurrence,and more AVR in patients with moderate to severe AR.