title: Long-term results of aortic valve regurgitation after repair of ruptured sinus of valsalva aneurysm.
abstract: BACKGROUND
  We reviewed our 35-year-experience to investigate the determinants of long-term results of aortic valve regurgitation (AR) after surgical repair of ruptured sinus of Valsalva aneurysms (RSVA).
  
  
  METHODS
  Between 1963 and 1998, a total of 35 patients aged 7 to 64 years underwent surgery for RSVA. The aneurysms ruptured into the right ventricle (n = 24), right atrium (n = 10), and left atrium (n = 1). In all, 19 patients had VSD and 9 patients had AR. A combined approach through aortotomy and the involved chamber was used for 24 patients. Either direct (n = 19) or patch (n = 16) closure was used to close the rupture hole. The AR was graded on a scale of 0 to IV by angiographic or echographic evaluation.
  
  
  RESULTS
  There were no early deaths. Late death occurred in 1 patient, whose AR deteriorated to grade III 20 years later. Two patients (5.7%) required reoperations on the aortic valve, because grade III AR was noted 8 and 26 years after operation, respectively. Freedom from postoperative grade III AR or higher was 93% at 10 years and was 87% at 20 years. Late AR was associated with preoperative and early postoperative AR (p < 0.05) but not with the presence of VSD, location of the fistula, surgical approach, or type of repair (direct vs patch). Multivariate analysis indicated that early postoperative AR was the only independent variable.
  
  
  CONCLUSIONS
  Late AR necessitating reoperation still confers significant risk in the long-term follow-up after repair of RSVA. No particular risk factor of preoperative conditions and surgical methods was elucidated in this study, and postoperative AR at discharge from the hospital was the only factor determining the long-term results of AR.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan. muratosh@med.hokudai.ac.jp
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Murashita
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kubota
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kamikubo
authors.forename: Norihiko
authors.initials: N
authors.lastname: Shiiya
authors.forename: Keishu
authors.initials: K
authors.lastname: Yasuda
mesh_terms: D000293:Adolescent; D000328:Adult; D001014:Aortic Aneurysm / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000601:surgery*