title: Surgery for ruptured sinus of Valsalva aneurysm: 25-year experience with 55 patients.
abstract: OBJECTIVE
  Different surgical strategies have been evolved for the surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA) from simple primary closure to patching of the rupture site by a dual chamber approach. We reviewed our 25-year experience and current literature regarding the efficacy of different surgical approaches.
  
  
  METHODS
  A retrospective review identified 55 patients who underwent RSVA repair between 1985 and 2011. The mean age was 30.9 ± 12.1 years. The RSVA originated from the right coronary sinus in 43 patients (78.2%), from the non-coronary sinus in 11 (20.0%) and from the left in 1. Rupture into the right ventricle was the most common result (n = 38). Dual-chamber exposure (the involved chamber and aorta) was used in 67.3% of the patients and isolated trans-aortic approach was used in 32.7%. RSVA was repaired with either a patch (n = 43) or direct sutures (n = 12), whereas the aortic valve was replaced in eight patients among the last group.
  
  
  RESULTS
  The hospital mortality rate was 3.6%. The follow-up was available in 94.3% (50 patients) of survivors ranging from 1 month to 25 years (mean 15.3 ± 4.1 years). There were five late deaths. Recurrence of the fistula was seen in two primarily repaired (two of four patients) and none of the patched-closed patients. Actual survival was 93.4 ± 3.7% at 10 years and 87.1 ± 5.6% at 15 years. Freedom from reoperations was 81.6 ± 6.1% at 15 years.
  
  
  CONCLUSIONS
  Surgical treatment for RSVA carries an acceptably low operative risk and long-term freedom from death and reoperation. Surgical approach must be chosen according to the ruptured chamber and associated lesions. Patch repair of RSVA must be preferred.
authors.affiliation: Department of Cardiovascular Surgery,  Kosuyolu Heart and Research Hospital, Istanbul,  Turkey.
authors.forename: Sabit
authors.initials: S
authors.lastname: Sarikaya
authors.forename: Taylan
authors.initials: T
authors.lastname: Adademir
authors.forename: Ahmet
authors.initials: A
authors.lastname: Elibol
authors.forename: Fuat
authors.initials: F
authors.lastname: Büyükbayrak
authors.forename: Alper
authors.initials: A
authors.lastname: Onk
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001019:Aortic Rupture / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery*; D016019:Survival Analysis