| Background:Sinus of Valsalva Aneurysms(SOVAs)are rare cardiac anomalies.The morbidity was still unknown,however,it was reported of 0.09%in cadavers by autopsy series and 0.14%to 0.23%in patients by surgical series.SOVAs were generally asymptomatic,but the prognosis of untreated Ruptured Sinus of Valsalva Aneurysm(RSVA)was very poor,with a expecting life span less than 1 year.Because of the low morbidity,as well as frequently being reported in case series,we were lacking of comprehensive understanding of the clinical features,therapeutic strategies and clinical prognosis of SOVA.We collected case series and cohort studies aiming to systematically evaluated and explored the epidemiological characteristics,clinical features and the relationship between therapeutic approaches and clinical prognosis of SOVAs.The study aimed to deepen the understanding of SOVAs and improve the standardized and individualized management of the diseases.Methods:Electronic databases and presentation from cardiovascular conferences were systematically searched from October 1974 to December 2018,and we analyzed the epidemiological demographic data(including age,gender,region,ethnicity,etc.),pathology Anatomical features,clinical manifestations,treatments strategy,clinical outcomes,Perioperative complications and clinical prognosis,etc.Moreover,we conducted subgroup analysis in different ethnic groups.Our data was analysed by SPSS 22.0.A P-value of<0.05 was considered to be statistically significant.Result:In total,47 case series and cohort studies were enrolled and systematically reviewed.The results showed that:①There was a significant difference between male and female in morbidity,males to female ratio is about 2:1,the average age of onset was 33.3±7.8 years ranging from 2 to 75 years old,Moreover,the Asian patients were younger than Caucasian patients(P<0.05)and the ratio of Asians to Caucasians is about 10:1.②Caucasians were more likely to have chest tightness,palpitations,dyspnea and fatigue symptoms(P<0.05).③SoVAs of the Asians usually originated from the right coronary sinus but less likely from the left coronary sinus and the non-coronary sinus.In addition,SOVAs of the Asians were apt to break into the right ventricle and less likely into the left ventricle.The most common comorbidities of Asian SOVA patients were ventricular septal defect,tricuspid regurgitation and mitral regurgitation,while aortic regurgitation,bicuspid aortic valve and other structural heart disease were less common(P<0.05).④ There were no statistics differences in the improvement of NYHA class between patients accepted percutaneous closure and surgical repair indicated that the treatments were equally effective in the improvement of cardiac function.Although the incidence rate of hemolysis and residual shunt after percutaneous closure was higher than that of surgical repair(P<0.05),there were no significant differences in perioperative hemorrhage,thrombosis,eardiac infection,arrhythmia,reoperation due to residual shunt,postoperative mortality and cardiovascular mortality,etc.between patients accepted percutaneous closure and surgical repair(P>0.05).Furthermore,the all-cause mortality rate decreased in patients accepted percutaneous closure(P<0.05).Conclusion:There were significant differences between Asians and Caucasians patients in clinical manifestations,gender,pathological anatomy,and comorbidities.Percutaneous closure is generally equal to surgical repair in terms of clinical efficacy and perioperative safety,however,it decreases all-cause mortality.Given that,it may be a promising therapeutical strategy,which needed to be approved by randomized controlled clinical trials. |
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