title: Sinus of Valsalva aneurysm or fistula: management and outcome.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Takach
authors.forename: G J
authors.initials: GJ
authors.lastname: Reul
authors.forename: J M
authors.initials: JM
authors.lastname: Duncan
authors.forename: D A
authors.initials: DA
authors.lastname: Cooley
authors.forename: J J
authors.initials: JJ
authors.lastname: Livesay
authors.forename: D A
authors.initials: DA
authors.lastname: Ott
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002932:Cineangiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*