Ruptured sinus of valsalva aneurysm: early recurrence and fate of the aortic valve

Background. We reviewed our experience with congenital ruptured sinus of Valsalva aneurysms (RSVA) to determine patterns of early recurrence and the fate of the aortic valve (AV). Methods. Over a 28-year period, RSVA was identified in 34 patients, (mean age 31.6 years). Primary closure of the RSVA was performed in 10 patients, and a patch employed in 24. Aortic insufficiency was present in 24 patients. AV replacement (AVR) was performed in 5 patients; AV repair in 6. Results. Follow-up of 9.2 ± 8.3 years (6 months to 24 years) was complete in all but 2 patients. Five early fistula recurrences (in 4 patients) correlated with primary rather than patch closure (p< 0.03). Kaplan-Meier survival at 10 years is 90 ± 7%. Freedom from reoperative AVR at 10 years is 83 ± 9%. Late AVR was performed in 6 patients for progressive aortic insufficiency due to bicuspid valve (n = 3), cusp disease of affected sinus (n = 2), or aortic root dilatation (n = 2). Conclusions. Patch closure of the RSVA should be routinely employed. A bicuspid valve may be associated with the late need for AVR.