title: Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm.
abstract: BACKGROUND
  The past decade has witnessed considerable improvement in implantation techniques for percutaneous closure of ruptured sinus of Valsalva aneurysm. This study was undertaken to compare the immediate results and mid-term follow-up of traditional surgery and percutaneous closure of ruptured sinus of Valsalva aneurysm in China.
  
  
  METHODS
  Between January 1993 and January 2013, a total of 35 patients with ruptured sinus of Valsalva aneurysm were enrolled for attempted closure in our institution. Twenty patients (57.1%) underwent surgical repair and the other 15 patients (42.9%) underwent percutaneous closure.
  
  
  RESULTS
  Nineteen patients (95.0%) in the surgical group had complete closure and 14 patients (93.3%) in the percutaneous closure group were treated successfully (p=0.681). Twelve patients with ruptured sinus of Valsalva aneurysm combined with subarterial ventricular septal defect (VSD) underwent surgical repair concomitantly. Two patients in the percutaneous closure group were treated for ruptured sinus of Valsalva aneurysm and perimembranous VSD using occluders concomitantly. One case of severe hemolysis developed 8h after the procedure in the percutaneous closure group. One death and one case of patch leak occurred in the surgical group during hospitalization. The time of hospital stay in the percutaneous closure group was shorter than that in the surgical group (p=0.004). The total medical cost of isolated ruptured sinus of Valsalva aneurysm in the percutaneous closure group was lower compared with that in the surgical group (p=0.046). During a median follow-up of 15 months (2-240 months), there were no deaths, infective endocarditis, device embolization, or malposition.
  
  
  CONCLUSIONS
  Percutaneous closure is an attractive alternative to surgery in selected patients with ruptured sinus of Valsalva aneurysm for the better clinical advantages and economic benefits.
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Suxuan
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Xu
authors.affiliation: Cardiovascular Therapeutic Centre, 117 Hospital of the Chinese People's Liberation Army, Zhejiang Province, China; Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xueyan
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Guanzhong
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: chcardiovasology@foxmail.com.
authors.forename: Xianxian
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: qin.yongwen@foxmail.com.
authors.forename: Yongwen
authors.initials: Y
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device / Q000191:economics; D012850:Sinus of Valsalva / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000191:economics / Q000379:methods; D055815:Young Adult
keywords: Aneurysm; Catheterization; Surgery; Valsalva