[Clinical analysis of 68 patients with ruptured sinus of Valsalva aneurysm].

OBJECTIVE

To evaluate the clinical characteristics, diagnosis, treatment and prognosis of ruptured aneurysm of the sinus of Valsalva (ASV).

METHODS

Sixty-eight cases of ruptured ASV treated in our hospital from 1986 to 1998 were retrospectively analyzed.

RESULTS

The ratio of male to female was 1.8:1 in 68 patients (44 males, 24 females). The mean age was (29.5 +/- 10.7) years (8-60 years). The proportion of ruptured aneurysms originating from the right coronary and noncoronary sinus was 79.4% and 20.6% respectively. Sixty-seven point six percent of ASV ruptured into right ventricle and 32.3% into right atrium. The incidence of ventricular septal defect and aortic valve insufficiency was 48.5% and 20.6% respectively. The former only existed in those patients whose ASV originating from the right coronary sinus and rupturing into right ventricles. There was a significant correlation between sudden onset of symptoms and fistulating of ASV into right atrium and a significant difference as compared with those fistulating into right ventricle (P < 0.001). Diagnostic sensitivity and specificity of echocardiography in ruptured ASV was 97.1% and 100% respectively, but the rate of missing subarterial ventricular septal defect was 24.2%. Sixty-seven patients received operation, one died of pulmonary embolism six weeks after operation. Thirty-six patients were followed up, the mean follow-up period was 6.5 years (range 1 to 16 years). Two patients were reoperated for leak of ventricular septal defect and aortic regurgitation. The cardiac function of sixteen patients were found to be of NYHA class I, seventeen of class II and three of class III.

CONCLUSION

Echocardiography in combination with aortography is an accurate diagnostic method for ruptured ASV and the prognosis in majority of the patients operated in time is good.