Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Repair and Long Term Results in Sinus of Valsalva Aneurysm: Twelve Year Experience

발살바동 동맥류의 외과적 치료 및 장기 결과

  • 방정희 (동아대학교 의과대학 흉부외과) ;
  • 조광현 (인제대학교 의과대학 부산 백병원 흉부외) ;
  • 우종수 (동아대학교 의과대학 흉부외과)
  • Published : 2004.07.01
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Abstract

Sinus of Valsalva aneurysm is a rare cardiac anomaly and a long-term survival after surgical treatment has not been well established. This study was designed to evaluate the long-term surgical results after the repair of sinus Valsalva aneurysm. Material and Method: From April 1991 to November 2003, 35 patients (23 male, 12 female, mean age 35.2 years, range 11∼64) underwent operation for sinus of Valsalva aneurysm. Twenty six patients (74.3%) were in the New York Heart Association (NYHA) class III∼IV before surgery. In preoperative echocardiogram, mean EF was 63.32 $\pm$ 11.43% and nine patients (25.7%) were in AR grade III∼IV. Direct closure, patch closure of ruptured sinus Valsalva were performed in fourteen patients (46.7%), sixteen patients (53.3%) respectively. Aortic valve replacement, valvuloplasty were performed in five patients (14.3%), three patients (8.6%) respectively. Three patients (8.6%) underwent the Bentall procedure. Concomitant procedures were performed in 15 patients (42.9%), which were closure of VSD and ASD. Mean CPB time and ACC time were 116.79 $\pm$ 38.79 and 81.2 $\pm$ 28.97 minutes. Result: There was no operative mortality. One patient (2.9%) developed complete heart block that required a permanent pacemaker implantation. Three patients (8.6%) required reoperation due to a recurred rupture of the sinus Valsalva aneurysm and developed aortic insufficiency. Mean follow-up time was 58.55 $\pm$ 38.38 months. There was one late death. Actuarial 5 year freedom rate from reoperation was 87.1 $\pm$ 7%. Conclusion: Surgical treatment for sinus of Valsalva aneurysm is safe and has satisfactory long-term results.

발살바동 동맥류는 드문 심장 기형으로 수술 후 장기 생존율이 잘 알려져 있지 않다 본 연구는 발살바동 동맥류의 수술적 치료 후 장기 성적을 알아보고자 하였다. 대상 및 방법: 1991년 1991년 3월부터 2003년 11월까지 발살바동 동맥류로 수술한 35명(남자 23, 여자 12, 평균 연령 35.2세, 범위 11세∼64세)의 환자를 대상으로 하였다. 술 전 NYHA 기능적 분류는 26명(74.3%)에서 class III∼IV였다. 술 전 심초음파상 평균 심구출률은 63.32 $\pm$ 11.43%였고 9명(25.7%)의 환자는 대동맥 판막 폐쇄 부전 grade III∼IV였다. 발살바동 파열부위의 수술은 직접 봉합이 14예(46.7%), 첩포를 이용한 폐쇄는 16예 (53.3%)에서 시행되었다. 대동맥 판막 치환술은 5예에서(14.3%) 성형술은 3예에서(8.6%) 시행되었다. 그리고 3명(8.6%)의 환자에서는 Bentall's 수술을 했으며 동반된 수술은 심실 중격 결손 폐쇄 12예 (34.3%), 심방 중격 결손 폐쇄 3예(8.6%)였다. 평균 심폐체외순환 시간은 116.79 $\pm$ 38.79분이었고 평균 대동맥 차단 시간은 81.2 $\pm$ 28.97분이었다. 결과: 수술 사망은 없었다. 1예에서 완전 방실 차단으로 영구 심장 박동기를 삽입했다. 재수술은 3예에서 시행하였는데 1예는 발살바동 동맥류 재발로 직접 봉합했고 1예는 대동맥 판막 기능 부전이 악화되어 인공 판막 치환술을, 1예는 인공 판막 치환술 후 판막 열개로 Bentall's 수술을 시행했다. 평균 추적 기간은 58.55$\pm$38.38개월이었으며 만기 사망은 1예 있었다. 5 year freedom from reoperation rate는 87.1 $\pm$ 7%였다. 결론: 발살바동 동맥류의 수술적 치료는 안전하며 만족할 만한 결과를 얻었다.

Keywords

References

  1. A Treatise on the diseases of the heart and great vessels(3rd ed.) Hope,J.(ed.)
  2. J Thorac Cardiovasc Surg v.99 Ruptured aneurysms of the sinus of Valsalva in Oriental patients Chu,S.H.;Hung,C.R.;How,S.S.(et al.)
  3. Ann Surg v.146 Surgical treatment of ruptured aneurysms of the sinus of Valsalva Lillehei,C.W.;Stanley,P.;Varco,R.L.
  4. Surgery v.41 Surgical treatment for aneurysms of the aortic sinuses with aorticoatrial fistula: experimental and clinical study Sawyers,J.L.;Adams,J.E.;Scott,H.W.Jr.
  5. Ann Thorac Surg v.68 Sinus of valsalva aneurysm or fistula: management and outcome Takach,T.J.;Reul,G.J.;Duncan,J.M.(et al.) https://doi.org/10.1016/S0003-4975(99)01045-0
  6. Cardiac surgery(3rd ed.) Congenital sinus of Valsalva aneurysm Kirklin,J.W.;Barratt-Boyes,B.G.;Kirklin,J.W.(ed.);Barratt-Boyes,B.G.(ed.)
  7. Ann Thorac Surg v.66 Repair of ruptured sinus of Valsalva aneurysm: Determinants of longterm survival Au,W.K.;Chiu,S.W.;Mok,C.K.(et al.) https://doi.org/10.1016/S0003-4975(98)00782-6
  8. Ann Thorac Surg v.70 Ruptured sinus of Valsalva aneurysm: early recurrence and fate of the aortic valve Azakie,A.;David,T.E.;Peniston,C.M.;Rao,V.;Williams,W.G. https://doi.org/10.1016/S0003-4975(00)01734-3
  9. Korean J Thorac Cardiovasc Surg v.29 Surgical treatment of aneurysm of the sinus of valsalva: eight year experience Oh,S.J.;Yoo,W.J.;Lee,H.S.;Ku,B.I.;Kim,C.H.
  10. Ann Thorac Surg v.19 Aneurysm and fistula of the sinus of Valsalva Meyer,J.;Wukasch,D.C.;Hallman,G.L.;Cooley,D.A. https://doi.org/10.1016/S0003-4975(10)63999-9
  11. Circulation v.90 no.SUP.2 Longterm outcome of sugical repair of ruptured sinus of Valsalva aneurysm Van Son,J.A.M.;Danielson,G.K.;Schaff,H.V.(et al.)
  12. Contributions to medical and biological research Clinical and developmental study of a case of ruptured aneurysm of the right anterior aortic sinus of Valsalva, leading to communication between the aorta and base of the right ventricle, diagnosed during life, opening in anterior interventricular septum (probably bulbar septal defect. Malignant endocarditis Abbott,M.E.
  13. Thorax v.12 The pathological anatomy of deficiencies between the aortic root and the heart, including aortic sinus aneurysms Edward,J.E.;Burchell,H.B. https://doi.org/10.1136/thx.12.2.125
  14. Ann Thorac Surg v.74 Ruptured sinus of Valsalva aneurysm: A Beijing experience Dong,C.;Wu,Q.Y.;Tang,Y. https://doi.org/10.1016/S0003-4975(02)03987-5
  15. Ann Thorac Surg v.73 Long term results of aortic valve regurgitation after repair of ruptured sinus of Valsalva aneurysm Murashita,T.;Kubota,T.;Kamikuro,Y.;Shiiya,N.;Yasuda,K. https://doi.org/10.1016/S0003-4975(02)03493-8