Progression of Aortic Regurgitation in Asian Patients with Congenital Sinus of Valsalva Aneurysm
DOI:
https://doi.org/10.1532/HSF98.20131019Abstract
Background: We reviewed the experience of An Zhen and Fu Wai Hospital for congenital sinus of Valsalva aneurysm (SVA) to determine risk factors for aortic valve replacement (AVR) and postoperative progression of aortic regurgitation (AR).
Methods: Over a 7-year period, 255 patients underwent surgical repair of an SVA. Aneurysms originated from the right sinus and the noncoronary sinus in 212 patients (83.1%) and 38 patients (14.9%), respectively, and protruded into the right ventricle and right atrium in 171 patients (67.1%) and 80 patients (31.4%), respectively. AR presented in 142 patients (55.7%), 60 patients underwent AVR, and 13 patients underwent aortic valvuloplasty (3 patients eventually received AVR for valvuloplasty failure).
Results: All patients survived the operation. Late death occurred in 2 patients (0.8%), and 2 patients (0.8%) experienced anticoagulation-related complications. Logistic regression analysis revealed that infective endocarditis, the cardiothoracic ratio, and a nonruptured SVA were risk factors for AVR. Late follow-up of 150 patients by echocardiographic assessment revealed that AR improved in 17 patients and worsened in 20 patients. Cox regression analysis revealed AR at discharge to be an independent risk factor for AR aggravation at late follow-up.
Conclusions: SVA can be repaired with low mortality and excellent long-term results. AR at discharge is an important factor in determining AR aggravation at late follow-up after the operation. We recommend early diagnosis and aggressive treatment for SVA.
References
Au WK, Chiu SW, Mok CK, Lee WT, Cheung D, He GW. 1998. Repair of ruptured sinus of Valsalva aneurysm: determinants of long-term survival. Ann Thorac Surg 66:1604-10.nCannegieter SC, Rosendaal FR, Briet E. 1994. Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89:635-41.nChoudhary SK, Bhan A, Sharma R, Airan B, Kumar AS, Venugopal P. 1997. Sinus of Valsalva aneurysms: 20 years' experience. J Card Surg 12:300-8.nChu SH, Hung CR, How SS, et al. 1990. Ruptured aneurysms of the sinus of Valsalva in Oriental patients. J Thorac Cardiovasc Surg 99:288-98.nDong C, Wu QY, Tang Y. 2002. Ruptured sinus of Valsalva aneurysm: a Beijing experience. Ann Thorac Surg 74:1621-4.nEdwards JE, Burchell HB. 1957. The pathological anatomy of deficiencies between the aortic root and the heart, including aortic sinus aneurysms. Thorax 12:125-39.nElgamal MA, Hakimi M, Lyons JM, Walters HL 3rd. 1999. Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricular septal defect. Ann Thorac Surg 68:1350-5.nFaillace RT, Greenland P, Nanda NC. 1985. Rapid expansion of a saccular aneurysm on the left coronary sinus of Valsalva: a role for early surgical repair. Br Heart J 54:442-4.nGoldberg N, Krasnow N. 1990. Sinus of Valsalva aneurysms. Clin Cardiol 13:831-6.nHering D, Piper C, Bergemann R, et al. 2005. Thromboembolic and bleeding complications following St. Jude Medical valve replacement: results of the German Experience with Low-Intensity Anticoagulation Study. Chest 127:53-9.nHonda J, Yonaha T, Nakamura Y, Uechi N, Asato H. 2009. Ruptured aneurysm of the sinus of Valsalva protruding into the pulmonary artery. J Thorac Cardiovasc Surg 137:e37-9.nJung SH, Yun TJ, Im YM, et al. 2008. Ruptured sinus of Valsalva aneurysm: transaortic repair may cause sinus of Valsalva distortion and aortic regurgitation. J Thorac Cardiovasc Surg 135:1153-8.nLiu YL, Liu AJ, Ling F, et al. 2011. Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm. Ann Thorac Surg 91:542-8.nMaruo A, Higami T, Obo H, Shida T. 2003. Ruptured sinus of Valsalva aneurysm associated with aortic regurgitation caused by hemodynamic effect solely. Eur J Cardiothorac Surg 24:318-9.nMiyatake K, Okamoto M, Kinoshita N, et al. 1984. Clinical applications of a new type of real-time two-dimensional Doppler flow imaging system. Am J Cardiol 54:857-68.nMoustafa S, Mookadam F, Cooper L, et al. 2007. Sinus of Valsalva aneurysms47 years of a single center experience and systematic overview of published reports. Am J Cardiol 99:1159-64.nMurashita T, Kubota T, Kamikubo Y, Shiiya N, Yasuda K. 2002. Long-term results of aortic valve regurgitation after repair of ruptured sinus of Valsalva aneurysm. Ann Thorac Surg 73:1466-71.nNaka Y, Kadoba K, Ohtake S, et al. 2000. The long-term outcome of a surgical repair of sinus of Valsalva aneurysm. Ann Thorac Surg 70:727-9.nRaffa H, Mosieri J, Sorefan AA, Kayali MT. 1991. Sinus of Valsalva aneurysm eroding into the interventricular septum. Ann Thorac Surg 51:996-8.nRathore KS. 2006. Aortic regurgitation with ventricular septal defect in the young. Asian Cardiovasc Thorac Ann 14:93-7.nRergkliang C, Chittithavorn V, Chetpaophan A, Vasinanukorn P. 2005. Surgery for aortic insufficiency associated with ventricular septal defect. Asian Cardiovasc Thorac Ann 13:61-4.nSim EK, Grignani RT, Wong ML, et al. 1999. Outcome of surgical closure of doubly committed subarterial ventricular septal defect. Ann Thorac Surg 67:736-8.nTakach TJ, Reul GJ, Duncan JM, et al. 1999. Sinus of Valsalva aneurysm or fistula: management and outcome. Ann Thorac Surg 68:1573-7.nTaylor NE, O'Brien S, Edwards FH, Peterson ED, Bridges CR. 2005. Relationship between race and mortality and morbidity after valve replacement surgery. Circulation 111:1305-12.nTrusler GA, Moes CA, Kidd BS. 1973. Repair of ventricular septal defect with aortic insufficiency. J Thorac Cardiovasc Surg 66:394-403.nvan Son JA, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB. 1994. Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. Circulation 90:II20-9.nVural KM, Sener E, Tasdemir O, Bayazit K. 2001. Approach to sinus of Valsalva aneurysms: a review of 53 cases. Eur J Cardiothorac Surg 20:71-6.nWang ZJ, Zou CW, Li DC, et al. 2007. Surgical repair of sinus of Valsalva aneurysm in Asian patients. Ann Thorac Surg 84:156-60.nWarnes CA, Maron BJ, Jones M, Roberts WC. 1984. Asymptomatic sinus of Valsalva aneurysm causing right ventricular outflow obstruction before and after rupture. Am J Cardiol 54:1383-4.nYacoub MH, Khan H, Stavri G, Shinebourne E, Radley-Smith R. 1997. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of Valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg 113:253-60; discussion 261.nYan F, Huo Q, Qiao J, Murat V, Ma SF. 2008. Surgery for sinus of Valsalva aneurysm: 27-year experience with 100 patients. Asian Cardiovasc Thorac Ann 16:361-5.nYang YL, Xie MX, Cheng TO, Wang XF, Lu Q, Ghoorah D. 2010. Left coronary sinus of Valsalva aneurysm ruptured into the left ventricle: diagnosis by two-dimensional and real time three-dimensional echocardiography. Int J Cardiol 151:e35-6.n
