Ruptured Sinus of Valsalva Aneurysm: 10-Year Experience at Kaohsiung Veterans General Hospital

主動脈竇瘤破裂：高雄榮民總醫院十年來之經驗

趙廷光(Ting-Kuang Chao) ； 鄭國琪(Kwok-Kei Cheng) ； 康沛倫(Pei-Leun Kang)

《Formosan Journal of Surgery》 37卷4期 (2004/07) Pp. 155-162

https://doi.org/10.29833/FJS.200407.0002

摘要

自1993年至2002年期間，一共有10個主動脈竇瘤破裂的病人接受外科手術治療。其中有6位男性及4位女性，平均年齡為26.7歲，其佔心臟外科手術發生率為0.27%。所有的主動脈竇瘤都發生在右冠狀竇，其中9個破裂至右心室，l個至右心房，這些病人當中有4個有中至重度的主動脈逆流，而所有病人都有心室中隔缺損。
手術治療方式包括切除主動脈竇瘤及以人工血管墊片修補，心室中隔缺損修補及主動脈瓣置換或修補。在手術後追蹤方面，所有病人術後復原情況良好，沒有死亡或復發情況產生。
因此，以外科手術方法來治療主動脈竇瘤破裂是一種安全且手術危險性低的方法，而以人工血管墊片來修補破洞缺損為一相當可行的方式。
手術治療方式包括切除主動脈竇瘤及以人工血管墊片修補，心室中隔缺損修補及主動脈瓣置換或修補。在手術後追蹤方面，所有病人術後復原情況良好，沒有死亡或復發情況產生。
因此，以外科手術方法來治療主動脈竇瘤破裂是一種安全且手術危險性低的方法，而以人工血管墊片來修補破洞缺損為一相當可行的方式 •

並列摘要

We reviewed our 10 patients receiving repair of ruptured sinus of Valsalva aneurysm (RSVA) over 10 years.
Methods: Between 1993 and 2002, a total of 10 cases of ruptured sinus of Valsalva aneurysm underwent surgical correction. These patients included six men and four women, with a mean age of 26.7 6.5 years (range 15-36 years). The incidence of RSVA in our cardiac surgical population was 0.27%. All 10 RSVA cases had their origin in the right coronary sinus, with aneurysms ruptured into the right ventricle in nine, and one into the right atrium. All 10 patients had a VSD (supracristal type
in eight and perimembranous type in two), and four patients had moderate to severe aortic regurgitation diagnosed by preoperative echocardiogram and cineoangiogram. Associated findings included a history of endocarditis (1 case; 10%), and a secundum type atrial septal defect (1 case, 10%). Concomitant procedures were VSD repair in all patients, aortic valvuloplasty in four, aortic valve replacement in one, and ASD repair in one.
Results: There was no early death or recurrence after the initial repair. No early or late complications occurred. One patient had SBE with severe AR received aortic valve replacement nine months after the initial operation. All patients who received aortic valve repair did not have more than grade I AR. All patients were in NYHA class I or II at their last follow-up.
Conclusions: Surgical treatment of ruptured SVAs can be performed with an acceptably low operative risk ensuring good long-term event-free/symptom-free survival. Patch repair strategy is advocated from the experience of our RVSA cases.

並列關鍵字

ruptured sinus of Valsalva aneurysm (RSVA) ； atrial septal defect (ASD) ； ventricular septal defect (VSD) ； subacute bacterial endocarditis (SBE) ； aortic regurgitation (AR), aortic insufficiency (AI)