Surgical Experience with Ruptured Aneurysms of the Sinuses of Valsalva

¹ Departments of Cardiovascular Surgery, The Hospital for Sick Children and Toronto General Hospital Toronto, ontario

The 14-year experience with 11 patients undergoing surgical correction of ruptured aneurysms of the sinus of Valsalva is presented. The age range was from 6 to 60 years at the time of diagnosis and correction. The origin and course of the resultant aortocardiac fistulae were as follows: noncoronary sinus to right atrium, one; right coronary sinus to right ventricle, six; right coronary sinus to right atrium, three; and right coronary sinus to left ventricle, one. All patients were in congestive failure at some time before operation, and in six the onset was sudden. All evinced a continuous precordial murmur on physical examination. Subacute bacterial endocarditis was documented in three patients and clinically suspected in a fourth. Two patients underwent previous exploratory operation for suspected patent ductus arteriosus. Cardiac catheterization was performed on all and revealed an oxygen increment in the recipient chamber. Cineangiograms outlined the abnormal communication. In two patients ventricular septal defect was associated and in one of these, in addition, a prolapsed aortic cusp was noted. Details of surgical management and longterm followup results will be presented.