Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm.
BACKGROUND
We reviewed our experience with congenital ruptured sinus of Valsalva aneurysms (RSVA) to determine risk factors influencing occurrence and postoperative worsening of aortic regurgitation (AR).


METHODS
Over an 11-year period, 210 patients (33 ± 9.7 years old) underwent surgical repair of RSVA. Aneurysm originated from the right noncoronary sinus and other sinuses in 171, 35 and 4 patients, respectively; and ruptured into right ventricle outlet tract in 115 patients, right ventricle in 16, right atrium in 75, and other chambers in 4. Aortic regurgitation (111) and ventricular septal defect (108) were common coexisting anomalies. Patch closure of RSVA was performed in 61 patients, direct sutures in 18 patients, patch closure plus direct sutures in 88 patients, and repair simultaneous with aortic valve replacement in 43 patients.


RESULTS
All but one patient survived the operation. In early postoperative periods, AR improved in 26 patients and worsened in 23. In 114 late follow-up patients with echocardiographic assessment, 18 showed deteriorated AR. By logistic regression analysis, RSVA ruptured into the right ventricle outlet tract and secondary changes of the aortic valve were risk factors for preoperative AR, and RSVA repaired with direct sutures had a significantly higher incidence of early worsening of AR. By Cox regression analysis, AR at discharge was an independent risk factor for late follow-up AR worsening.


CONCLUSIONS
The RSVA can be repaired with a low mortality and excellent long-term result. An early, aggressive treatment should be recommended to prevent postoperative AR, and a direct-suture closure of RSVA should be avoided to prevent early worsening of AR.
Department of Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China. liucardio@163.com
Ying-Long
YL
Liu
Ai-Jun
AJ
Liu
Feng
F
Ling
Dong
D
Wang
Yao-Bin
YB
Zhu
Qiang
Q
Wang
Xiao-Dong
XD
Lv
D000293:Adolescent; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000151:congenital* / Q000453:epidemiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006343:Heart Septal Defects / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult