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Thomas J. Takach
George J. Reul
J. Michael Duncan
Denton A. Cooley
James J. Livesay
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Ann Thorac Surg 1999;68:1573-1577
© 1999 The Society of Thoracic Surgeons

Original Articles

Sinus of valsalva aneurysm or fistula: management and outcome

Thomas J. Takach, MDa, George J. Reul, MDa, J. Michael Duncan, MDa, Denton A. Cooley, MDa, James J. Livesay, MDa, David A. Ott, MDa, O.H. Frazier, MDa

a Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA

Address reprint requests to Dr Cooley, Department of Cardiovascular Surgery, Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. Few large or long-term series exist regarding the management of patients with sinus of Valsalva aneurysms or fistulas (SVAFs).

Methods. Between 1956 and 1997, 129 patients presented with a ruptured (64 cases; 49.6%) or nonruptured (65 cases; 50.4%) SVAF. The patients included 88 men and 41 women, with a mean age of 39.1 years. Associated findings included a history of endocarditis (42 cases; 32.6%), a bicuspid aortic valve (21 cases; 16.3%), a ventricular septal defect (15 cases; 11.6%), and Marfan’s syndrome (12 cases; 9.3%). Operative procedures included simple plication (61 cases; 47.3%), patch repair (52 cases; 40.3%), aortic root replacement (16 cases; 12.4%), and aortic valve replacement/repair (75 cases; 58.1%).

Results. There were five in-hospital deaths (3.9%): four due to preexisting sepsis and endocarditis and one that followed dehiscence of the repair in a patient with Marfan’s syndrome. Two patients (1.6%) had strokes during the early postoperative period. The survivors were followed up for 661.1 patient-years (5.3 years/patient). The following late complications occurred: prosthetic valve malfunction (5 cases; 3.9%), prosthetic valve endocarditis (3 cases; 2.3%), SVAF recurrence (2 cases; 1.6%), thrombosis (1 case; 0.8%), and anticoagulation-related bleeding (1 case; 0.8%).

Conclusions. Resection and repair of SVAF entails an acceptably low operative risk and yields long-term freedom from symptoms. Early, aggressive treatment is recommended to prevent endocarditis or lesional enlargement, which causes worse symptoms and necessitates more extensive repair.




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