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Morphometric features of ruptured congenital sinus of Valsalva aneurysm: implication for surgical treatment
J A van Son1, E K Sim, A Starr
1Heart Institute, St. Vincent Hospital, Portland, Oregon, USA.
Insights
Congenital sinus of Valsalva aneurysms rupture sites differ between Caucasian and indigenous North American patients. Patch closure is recommended for ruptured sinus of Valsalva aneurysms.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Aortic Aneurysm
Background:
- Congenital sinus of Valsalva aneurysm is a rare condition.
- Rupture of these aneurysms can lead to serious complications.
Purpose of the Study:
- To investigate the anatomical location of ruptured congenital sinus of Valsalva aneurysms.
- To compare rupture sites across different ethnic groups.
- To determine the optimal surgical repair method.
Main Methods:
- Retrospective analysis of five cases with ruptured sinus of Valsalva aneurysms.
- Detailed examination of aneurysm location and rupture site.
- Histological analysis of aortic wall integrity.
- Review of surgical repair techniques.
Main Results:
- Rupture sites varied based on patient ethnicity.
- Caucasian patients showed ruptures near the noncoronary-right cusp commissure.
- Indigenous North American patients had ruptures near the right-left cusp commissure, often with associated defects.
- Rupture hole diameters ranged from 0.4 to 1.1 cm.
Conclusions:
- Congenital sinus of Valsalva aneurysm rupture sites may differ between Occidental and indigenous North American/Oriental populations.
- Patch closure is emphasized over suture closure for ruptured sinus of Valsalva aneurysms.
Abstract:
Five hearts with ruptured congenital sinus of Valsalva aneurysm were studied. In 3 hearts of Caucasian patients, the sinus of Valsalva aneurysms were located in the immediate vicinity of the commissure between the noncoronary and right aortic cusps with rupture from the noncoronary sinus to the right atrium (n = 2) and from the right sinus to the right ventricle (n = 1). In 2 hearts of indigenous North Americans, the defects were sited in the immediate vicinity of the commissure between right and left aortic cusps with rupture into the right ventricle; both patients had an associated conal septal hypoplasia ventricular septal defect and aortic insufficiency. The diameters of the rupture holes at the base of the sinus of Valsalva aneurysms in the five hearts ranged from 0.4 to 1.1 cm (mean 0.7 cm). Histologic examination of longitudinal sections through the ruptured sinus of Valsalva showed 0.8 to 1.7 cm (mean 1.1 cm) wide areas in which there was lack of continuity between the aortic media and the aortic annulus. Conclusions. This study shows that the site of congenital weakness in sinus of Valsalva aneurysm in indigenous North American patients may be similar to that in Oriental patients, whereas the site tends to be different in Occidental patients. It also emphasizes the importance of patch closure rather than suture closure of ruptured sinus of Valsalva aneurysms.