SURGICAL REPAIR OF RUPTURED SINUS OF VALSALVA ANEURYSM: EXPERIENCE AT CARDIOVASCULAR DEPARTMENT, LADY READING HOSPITAL, PESHAWAR

Objectives: To determine the frequency of ruptured sinus of Valsalva aneurysm (SVA) and to study its surgical outcome in terms of morbidity and mortality in our set up. Methodology: This case series study was conducted on 23 patients of ruptured SVA’s, were operated at  cardiovascular department, Lady reading hospital, Peshawar, from January 2003 to December 2011 and followed up till December 2013. Informed consent was taken  from all patients. Surgical repair was performed using cardiopulmonary bypass (CPB) via a median sternotomy. Age, sex, presentation, site and outcome of surgical repair were analyzed. Results: Ruptured SVA’s was more common in males (73.91%). Right coronary cusp was involved in 86.95% patients of the ruptured SVA’s cases. Most common ruptured site was right ventricle (91.30%). Aortic regurgitation was observed in 21.73% and ventricular septal defects in 13.04% cases. Primary closure of the defect with pladgeted stiches done in 86.95% cases while patch closure was done in 13.05% cases. Preoperatively, 34.78% & 52.17% patients were having NYHA functional status III & IV respectively, while postoperatively 45.45% & 36.36% patients were having NYHA functional status I & II respectively. Mortality was 4.35% (n=1/23) and one (4.35%) patient had residual leak and managed conservatively. Two years follow up showed no complication regarding ruptured SVA. Conclusions:  SVA are very uncommon anomalies in our setup, commonly involve right coronary cusp and rupturing mostly into right side of heart. Surgical repair of VSA is a safe procedure having good outcome in terms of morbidity and mortality.