Sanjeev DEVGARHA, Amita YADAV, Viju ABRAHAM, Anula SİSODİA, Rajendra MATHUR

Surgery for ruptured sinus of Valsalva aneurysm: Five-year experience with 19 patients

Amaç: Bu yazıda rüptüre sinüs Valsalva anevrizması (RSVA) tamirindeki beş yıllık deneyimimiz ve yama ile kapamanın etkinliğine ilişkin mevcut literatür incelendi.Çalışmaplanı:Retrospektif bir incelemeyle Ocak 2009 ve Ekim 2013 tarihleri arasında RSVA tamiri geçirmiş 19 hasta (15 erkek, 4 kadın; ort. yaş 28±12; dağılım 14-55 yaş) belirlendi. Rüptüre sinüs Valsalva anevrizması 17 hastada (%89.4) sağ koroner sinüsten, iki hastada (%10.5) nonkoroner sinüsten kaynaklanmaktaydı. Rüptüre sinüs Valsalva anevrizması hastaların hiçbirinde sol koroner sinüsten kaynaklanmamaktaydı. On bir hastada (%57.8) en yaygın olay sağ ventrikül rüptürüyken sekiz hastada (%42.10) sağ atriyum rüptürüydü. Yaygın ilişkili defektler iki hastada (%10.7) subaortik ventriküler septal defekt, yedi hastada (%36.8) aort yetmezliği ve bir hastada (%5.2) triküspid yetmezliği idi. Onarım için bikameral yaklaşım kullanıldı. Rüptüre sinüs Valsalva anevrizması tüm olgularda genişletilmiş politetrafloroetilen yama ile onarıldı. Yedi hastada aort kapağı, bir hastada triküspid değiştirildi.Bul gu lar: Hastane mortalite oranı %5.2 idi. Süresi bir ay ila 4.5 yıl arasında değişen takip, sağ kalanların %94.3'ü (n=18) ile yapıldı. Gerçek sağkalım oranı %95 idi. Tekrar ameliyattan uzak yaşam oranı %100 idi.So nuç: Rüptüre sinüs Valsalva anevrizması için en iyi tedavi seçeneğinin cerrahi tamir olduğu anlaşılmaktadır. Tanıdan sonra hızlı cerrahi girişim başarılı sonuçlar sağlayabilir.

Rüptüre sinüs Valsalva anevrizması için cerrahi: 19 hasta ile beş yıllık deneyim

Background: In this article, we reviewed our five-year experience in the repair of ruptured sinus of Valsalva aneurysm (RSVA), and the current literature regarding the efficacy of patch closure. Methods: A retrospective review identified 19 patients (15 males, 4 females; mean age 28±12 years; range 14 to 55 years) who underwent RSVA repair between January 2009 and October 2013. The RSVA originated from the right coronary sinus in 17 patients (89.4%), and from the noncoronary sinus in two patients (10.5%). Ruptured sinus of Valsalva aneurysm did not originate from the left coronary sinus in any of the patients. In 11 patients (57.8%), the most common occurrence was right ventricular rupture, whereas it was right atrial rupture in eight patients (42.10%). Common associated defects were subaortic ventricular septal defect in two patients (10.7%), aortic insufficiency in seven patients (36.8%), and tricuspid insufficiency in one patient (5.2%). A bicameral approach was used for repair. Ruptured sinus of Valsalva aneurysm was repaired with an expanded polytetrafluoroethylene patch in all cases. Aortic valve was replaced in seven patients, and tricuspid in one patient. Results: The hospital mortality rate was 5.2%. Follow-up, ranging from one month to 4.5 years, was available in 94.3% of survivors (n=18). Actual survival rate was 95%. Freedom from reoperation was 100%. Conclusion: To conclude, surgical repair appears to be the optimal choice for the treatment of RSVA. Rapid surgical intervention after diagnosis may lead to successful outcomes.

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