Surgical repair and long-term results in ruptured sinus of Valsalva aneurysm.

Thirty-one patients with a ruptured sinus of Valsalva aneurysm (SVA) were operated on between January, 1961, and December, 1987. Twenty-five patients (81%) were in New York Heart Association (NYHA) Functional Class III or IV. Coexistent cardiac anomalies included a ventricular septal defect (VSD) in 16 patients (52%) and aortic valve regurgitation in 12 patients (39%). The ruptured SVA originated from the right coronary sinus in 29 patients (94%) and the noncoronary sinus in 2 patients (6%), and drained into the right ventricle in 30 patients (97%). In 6 patients treated recently, we used patches to repair the ruptured SVA and VSD through a double approach, thereby avoiding a ventriculotomy. This method resulted in no recurrent rupture or residual VSD postoperatively. There was one operative death (3%) and 4 late deaths (13%). Of the 26 surviving patients, 22 (85%) were in NYHA Class I at follow-up ranging from 6 months to 26.7 years (mean, 11.1 years). Actuarial survival at 25 years is 85.6 +/- 7.4% (mean +/- standard deviation). Repair of ruptured SVA with a patch through a double approach provides an excellent operative procedure and offers a long-term outcome.