Modified Classification For Ruptured Sinus Of Valsalva Aneurysm

Objective: To summarize the application of modified Sakakibara classification system for ruptured sinus of Valsalva aneurysm on patients at The Second Hospital of Hebei Medical University, and the guiding significance on RSVA for the selection of surgical incision.Method: Retrospective analysis the clicnical data of 40 patients undergoing surgical repair for RSVA from Januray, 2004, to October2012, at The Second Hospital of Hebei Medical University. There were 29 male and 11 female patients with their age of 19-56 years, the average age is 32.1 years. All these patients were divided into 5 types as a modified Sakakibara classification system. Type I: rupture into the right ventricle just beneath the pulmonary valve(n=15),including 3 patients(84.8%) with ventricular septal defect(VSD) and 8 patients(53.8%) with aortic valve insuffi ciency(AI). Type Ⅱ:rupture into or just beneath the crista supraventricularis of the right ventricle(n=4),including 3 patients(75%) with VSD but no patient with AI. Type Ⅲ:rupture into the right atrium(type Ⅲa,n=5) or the right ventricle(type Ⅲv,n=1) near or at the tricuspid annulus,including 3 patients(50%) with VSD and 1 patient(16.7) with AI. Type Ⅳ:rupture into the right atrium(n=15),including 3 patients with AI but no patient with VSD. Type Ⅴ:other rare conditions,such as rupture into the left atrium,left ventricle or pulmonary artery( n=0). Most RSVA originated in the right coronary sinus(n=31),and the other 9 patients originated in the noncoronary sinus.There was no case originated in left coronary sinus in this study.Results:Repair of ruptured sinus of Valsalva aneurysm only through right ventricular outflow tract was used in 100% of those with type I and 75% of those with typeⅡ. All the type Ⅲv patients(100%)were received RSVA through aortotomy. Both routes of repair were used in 60% of patients with type IIIa, the others of type IIIa were received repair through right ventricular outflow tract. Sinus aneurysm rupture repair through right atrium was used in 53% of patients with type Ⅳ, 40% of the cases were received RSVA repair both through right atrium and aortotomy. There was no type Ⅴ case in all the cases. No deaths occurred in these 40 patients,there were 2 patients underwent reoperation because of the large pericardial drainage, the bleeding all caused by sternum fixing wire, and the patients had recovered well. Most patients received reinforcement patch for RSVA repair(n=37), and only 3 patients with type Ⅳ received simple suture repair. Aortic valve replacement was performed for 5 patients(including 4 patients with type Ⅰand 1 patient with type Ⅳ). A total of 36 patients were followed up from 4 to 60 months, the follow-up rate was 90%. 2 patients with residual shunt at repair place,continued observation and there was no increased on residual shunt by ultrasound test. There was no early and late deaths occurred for the 36 patients during the follow-up period.Conclusion: Modified Sakakibara classification system for RVSA provides a guidance for clinical doctors to choose an appropriate surgical approach,and satisfactory surgical treatment effect can be achieved for patients with all types of RSVA.