title: Surgery for sinus of Valsalva aneurysm: 33-year of a single center experience.
abstract: BACKGROUND
  Sinus of Valsalva aneurysm (SVA) is a rare anomaly and few large or long-term series are well established. This study was designed to review 33-year surgical experience of SVA in one center.
  
  
  METHODS
  From August 1980 to December 2013, patients with SVA underwent surgical repair were retrospectively studied.
  
  
  RESULTS
  A total of 160 patients were identified with mean age of (30±12) years and 112 (70%) of them were males. The right coronary sinus origin of SVA was found in 108 patients (67.5%), the non-coronary sinus in 51 patients (31.9%), and the left coronary sinus in one patient (0.6%). The rupture of SVA into the right ventricle was identified in 89 (55.6%) cases, the right atrium in 61 (38.1%), the left ventricle in 2 (1.3%) and no rupture in 8 (5.0%). Ventricular septal defect (VSD) and aortic regurgitation (AR) were found in 59 (37%) and 45 (28%) patients respectively. An approach via the involved chamber was used in 86 patients (54%), aortotomy in 8 (5%), and a combined approach in 66 (41%). Either direct suture (56, 35%) or patch (104, 65%) closure were used to repair the SVA. The VSD was closed with a patch (44/59, 75%) or direct suture (15/59, 25%). aortic valve replacement (AVR) was performed in 23/45 (51%) and aortic valvuloplasty (AVP) in 9/45 (20%) patients combined with AR. There were 3 hospital deaths (1.9%) and 2 late deaths and 84% of the patients were followed up for (17.6±4.2) years. New York Heart Association functional class improved significantly after surgery (P < 0.01). Actuarial survival was 94% at 10 years, and 88% at 20 years.
  
  
  CONCLUSIONS
  Surgical treatment of SVA is safe and effective, ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as possible. However, late progressive AR is still a risk during long-term follow-up, and early aggressive measures are recommended. These include more use of a combined approach to achieve optimal evaluation of lesions, more patch repairs to reduce the chance of recurrence, and more AVR in patients with moderate to severe AR.
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Yan
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.
authors.forename: Murat
authors.initials: M
authors.lastname: Abudureheman
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China. Email: yfheart@outlook.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Huo
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.
authors.forename: Askaer
authors.initials: A
authors.lastname: Shabiti
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhu
authors.affiliation: Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D001014:Aortic Aneurysm / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery*; D055815:Young Adult