| Surgical Treatment of the Ruptured
Aneurysm of the Valsalva Sinus Associated with Infective Endocarditis
of the Aortic and Pulmonary Valves |
| Takanori Ayabe |
Yasunori Fukushima |
Eiichi Chosa |
| Makoto Yoshioka |
Toshio Onitsuka* |
|
（Department of Surgery, Miyazaki Shigun-Ishikai
Hospital, Miyazaki, Japan and Department of SurgeryII, Miyazaki
Medical College*, Miyazaki, Japan)
|
A 30-year-old man with a fever,
cough, and dyspnea, was admitted to our hospital. A ruptured
aneurysm of the Valsalva sinus（Konno classification, type I）was
diagnosed associated with infective endocarditis of the aortic
valve accompanied by aortic regurgitation（AR, grade II)，and a
ventricular septal defect（VSD, subarterial type). The operation
was performed as follows: the removal of the aortic and pulmonary
valves involved with endocarditis, the resection of the right
aneurysm of the Valsalva sinus, and the myectomy of the fragile
tissue of the right ventricle around the VSD. As a result, the
large deficit region with the VSD and the resected right Valsalva
sinus was patched with double sheets of equine pericardium. Aortic
valve replacement（a prosthetic valve, ATS18AP）was anastomozed
to the closed patch with the aid of the sheet as a part of the
aortic valvular ring, and pulmonary valve replacement（a prosthetic
valve, ATS23A）was done to the native pulmonary valvular site.
During the 13 months after the surgery, under strict control
of warfarin administration, the patient's clinical outcome has
been favorable without infection and congestive heart failure.
This case had AR accompanied with the subarterial type VSD, and
aneurysmal formation of the Valsalva sinus and its rupture, and
also revealed progressive infective endocarditis of the aortic
and pulmonary valves, which resulted in severe cardiac failure.
Early and appropriate surgical treatment for the ruptured aneurysm
of the Valsalva sinus is required for a better prognosis prior
to prevent exacerbation leading to infective endocarditis and
critical heart failure.
Jpn. J. Cardiovasc. Surg. 31：61-64(2002) |
|
