[Surgical treatment of ruptured sinus of Valsalva aneurysm]

We operated on 3 patients with ruptured sinus of Valsalva aneurysm (RSVA). According to the classification by Konno, 2 of them had type I RSVA where aneurysm originated from the right coronary sinus rupturing into the right ventricle, and another type IV where it arose from the non-coronary sinus draining into the right atrium. Both of the 2 with type I RSVA had accompanied ventricular septal defect (VSD) of Kirklin type I. One of them had infective endocarditis with vegetations clinging to the aortic valve, the pulmonary valve and the right ventricular wall adjacent to VSD, and aortic regurgitation of grade II consequently occurred. In this patient, the aortic cusps and the wall of sinus of Valsalva aneurysm were taken out with vegetations. The defect of sinus and VSD were closed with one large patch and a 25 mm SJM aortic valve was implanted using the patch as a part of annulus. The other patient with type I RSVA received a direct closure of defect of Valsalva sinus and VSD. Another patient with type IV RSVA underwent a direct closure of right atrial wall where aneurysm protruded. All 3 patients are doing well without shunt and aortic regurgitation. In this paper, diagnosis, surgical treatment and outcome of RSVA were reviewed.