Sinus of valsalva aneurysm or fistula: management and outcome

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Presentation transcript:

Sinus of valsalva aneurysm or fistula: management and outcome Thomas J Takach, MD, George J Reul, MD, J.Michael Duncan, MD, Denton A Cooley, MD, James J Livesay, MD, David A Ott, MD, O.H Frazier, MD The Annals of Thoracic Surgery Volume 68, Issue 5, Pages 1573-1577 (November 1999) DOI: 10.1016/S0003-4975(99)01045-0

Fig 1 Primary repair options for sinus of Valsalva aneurysms. (A) Noncoronary sinus of Valsalva aneurysm extending into the right atrium. (B) Examination of aortic valve cusps. (C1) If the orifice is small, primary closure may be performed with interrupted sutures. (C2) If the orifice is large or if direct repair distorts the aortic leaflets, a Dacron patch is applied. The Annals of Thoracic Surgery 1999 68, 1573-1577DOI: (10.1016/S0003-4975(99)01045-0)

Fig 2 Exposure (A) and excision (B) of the aneurysmal sac. Alternative repair options include a purse-string closure (C) or Dacron patch repair. If a ventricular septal defect is present (inset), patch repair via a ventriculotomy is preferred. The Annals of Thoracic Surgery 1999 68, 1573-1577DOI: (10.1016/S0003-4975(99)01045-0)

Fig 3 Actuarial survival rate over time. The Annals of Thoracic Surgery 1999 68, 1573-1577DOI: (10.1016/S0003-4975(99)01045-0)

Fig 4 Enlargement of a sinus of Valsalva aneurysm over time. (A) Cineangiogram with dilated noncoronary sinus (arrow). (B) Computed tomographic scan, performed on the same patient 4 years later, showing a dilated aortic root (arrow). The aneurysm had enlarged to involve both the right and left coronary sinuses. It necessitated replacement of the aortic root and reimplantation of the coronary arteries. The Annals of Thoracic Surgery 1999 68, 1573-1577DOI: (10.1016/S0003-4975(99)01045-0)