Aneurysms of the sinus of Valsalva: Morphology and long term surgical results

Objective: One hundred and forty seven patients with aneurysm of sinus of Valsalva (ASV) underwent surgery between January 1977 and June 2000. The morphological features and the surgical outcome in these patients were analyzed. Patients and Methods: The age ranged from 5 to 62 years (mean 27.0±11.5 years), and all were congenital in aetiology. The aneurysm originated from the right coronary sinus in 116 (78.9%), from the non-coronary sinus in 25 (17%) from the left coronary sinus in 1 (0.6%) and from more than one sinus in 5 patients. In 14 patients (9.5%) the ASV remained unruptured. It ruptured into the right ventricle in 87, into the right atrium in 40 and into the left ventricle in 3 patients. In 11 instances, the ASV dissected into the interventricular septum. A ventricular septal defect was present in 63 (43%) patients and in the majority (n=56) it was subarterial. Moderate to severe aortic regurgitation was present in 43 patients. Surgical correction was through a bicameral approach (n=111) or through the aorta (n=28) or the chamber of rupture (n=8). Results: There were 3 operative deaths and 5 late deaths over a follow up of 2 months to 23 years (mean 100.7±64.7 months). Acturial and event free survival at 23 years were 94.0%±3.0% and 82.0%±6.0% respectively. Presence of moderate or severe aortic regurgitation was significantly associated with reduced event free survival. A comparison of the Indian patients with patients collected from the literature, revealed that the Indian patients represent a separate subset of patients and can be placed in middle of the spectrum between the Oriental and the Western patients. Conclusion: Indian patients represent a different set of patients. Adequate surgery yields gratifying early and late results. © 2000 IJTCVS.