Objective To evaluate contemporary management of sinus of Valsalva aneurysms.
Methods We reviewed the medical records of all patients, since 2000, presenting to UCLA with rare sinus of Valsalva aneurysms. Seven patients (6 males, 1 female) were identified with a mean age of 22.2 yrs (range, 6 wks to 45 yrs). Their mode of presentation, diagnosis and operative management were evaluated and compared to historical controls.
Results Forty-three percent (3/7) of cases presented unruptured. Patients with ruptured aneurysms presented with exercise intolerance, continuous murmurs and volume overload from left to right shunting. In every case, the aneurysm originated in the right coronary sinus, protruding or rupturing into the right ventricular outflow tract (RVOT) in 5, the right ventricle in 1 and the pulmonary artery in another. Color Doppler and 2-D echocardiography was the most common diagnostic tool (5), supplemented by cardiac catheterization (4) and transesophageal echocardiography (2). Predominant co-existing defects included VSD (6) and PFO (2). Four and one patient presented with important aortic and tricuspid regurgitation.Operative strategy required cardiopulmonary bypass and cardioplegia for myocardial protection. The aortic root was opened in all cases in addition to the communicating cardiac chambers and great vessels. Pericardium was used to repair the coronary sinus and obliterate the fistulous tract. Additional VSD closures (6), aortic valve repairs (4), PFO closures (2) and tricuspid valve repair (1) were performed. There was no patient mortality, residual shunting or valvular dysfunction.
Conclusion Contemporary surgical repair of rare sinus of Valsalva aneurysms yields excellent outcomes.