Aortic sinus aneurysm repair

Aortic sinus aneurysm rupture, also known as ruptured sinus of Valsalva aneurysm or sinus of Valsalva fistula, is relatively rare in clinical practice, accounting for 0.31% to 3.56% of congenital heart disease. The incidence rate in humans is five times higher than that in Westerners. It is due to the lack of normal elastic tissue and muscle tissue in the middle layer of the aortic sinus. Under the influence of intra-aortic pressure, the sinus wall gradually becomes thinner and expands outward to form a capsular bulge. , that is, aortic sinus tumor, protruding to the adjacent heart chamber, occasionally the left sinus or the sinus tumor without the coronary sinus protrudes out of the heart. Very few right coronary sinus sinus tumors can protrude into the interventricular septum. When the sinus tumor is not broken, it is generally asymptomatic. When a certain factor, such as strenuous activity or trauma, causes a sudden increase in intra-aortic pressure, the sinus tumor can be broken into the adjacent heart chamber, and acute cardiac insufficiency can occur clinically. The age at which sinus rupture occurs can range from a few years to over 60 years, 80% of patients are between 20 and 40 years old, and there are very few children, and men account for more than two-thirds. Treatment of diseases: aortic regurgitation Indication Aortic sinus repair is applicable to: 1. A ruptured aortic sinus tumor. 2. Aortic sinus aneurysm does not rupture but combined with ventricular septal defect or aortic regurgitation requires surgical correction. 3. Aortic sinus aneurysm does not rupture, but causes severe heart rhythm disorder or obvious right ventricular outflow tract obstruction due to large tumor sac. 4. A simple atrial ruptured aortic sinus tumor has the risk of sudden rupture causing acute cardiac tamponade. Contraindications Smaller aortic sinus aneurysms that are unruptured and asymptomatic. Preoperative preparation For patients with incomplete cardiac dysfunction, adequate cardiac, diuretic and vasodilator drugs, as well as bed rest, low-salt diet and intermittent oxygen inhalation should be given before surgery to improve cardiac function and general condition. Surgical procedure (a) transatrial aortic sinus tumor repair 1. The sternal midline incision. 2. Cut the happy package to verify the diagnosis. 3. Establish extracorporeal circulation. 4. After occlusion of the tumor with a happy cavity, the myocardial palsy was perfused or retrogradely perfused through the coronary sinus. 5. Select a heart incision based on the heart chamber of the aortic sinus tumor. (1) Aortic sinus aneurysm and rupture are revealed through the right ventricle. (2) Aortic sinus tumor and rupture are revealed through the right atrium. (3) Aortic sinus tumor and rupture are revealed through the left atrium. 6. After the tumor capsule is exposed, the wall of the capsule is removed, and a 4-0 double-headed needle with a spacer is used as an intermittent suture for 3 to 5 needles, and then a second layer of continuous suture is performed after ligation. 7. It is also possible to enlarge the tumor sac and only expand the tip of the sac. Use a double-headed needle with a shimming needle to insert the needle from the capsular neck, suture the sacral suture for one week, pass through the patch, and then suture the wall with a needle. Pass through the middle of the piece and ligature all the stitches one by one. (B) repair of aortic sinus tumor through the aortic root 1. The sternal midline incision. 2. Cut the happy package to verify the diagnosis. 3. Establish extracorporeal circulation. 4. After occlusion of the tumor with a happy cavity, the myocardial palsy was perfused or retrogradely perfused through the coronary sinus. 5. The aortic wall was cut transversely from 1.5 to 2.0 cm from the aortic annulus to reveal the breach. 6. When the sinus ostium is small, 4-0 with a double-headed needle can be used to suture the sinus ostium. When the sinus is large, the patch can be repaired. 7. Suture the aortic incision with a 4-0 polypropylene thread. (C) aortic sinus aneurysm repair with ventricular septal defect 1. The sternal midline incision. 2. Cut the happy package to verify the diagnosis. 3. Establish extracorporeal circulation. 4. After occlusion of the tumor with a happy cavity, the myocardial palsy was perfused or retrogradely perfused through the coronary sinus. 5. When the sinus tumor mouth and ventricular septal defect are small, 3-0 with a double-headed needle can be used for suture repair. 6. When the patch is larger, the patch should be repaired with the size of the two notches and the common long axis, and the padded suture or continuous suture can be used. complication The mortality rate of surgery is 0-12%, mostly below 10%. The main cause of death is low cardiac output syndrome and perioperative cardiac arrest. It is related to the need for simultaneous correction of poor cardiac function and cardiac malformation. Other complications include arrhythmia and aortic regurgitation, which is often caused by poor aortic valve formation or poor technique for repairing sinus tumors. In addition to aortic regurgitation, there are a few reports of late atrial aortic sinus tumor recurrence due to incomplete repair. In addition, there are complications associated with concurrent ventricular septal defect repair or aortic valve replacement, such as residual leakage, paravalvular leak, embolization or artificial valve infective endocarditis.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.