BACKGROUND:Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. CASE PRESENTATION:A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. CONCLUSIONS:Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.

译文

背景:窦静脉窦动脉瘤(SVA)是一种罕见的心脏异常,其发病率不到心脏直视手术病例的1%。它的进化通常是沉默的,偶然发现或在其急性破裂时被发现。由于未破裂的巨型SVA伸入心腔或冠状动脉受压,可能会导致异常的临床表现,并经常伴有各种严重程度的主动脉瓣关闭不全。 SVA的金标准治疗包括完全替换主动脉根部和瓣膜。但是,在某些情况下,阀保持程序可能被证明是更合适的选择。
病例介绍:一名68岁的男性患者,由于Valsalva动脉瘤的右窦大(> 5cm)而出现呼吸困难。动脉瘤占据了右心室的大部分,并伴有严重的主动脉瓣关闭不全。病情的外科治疗包括保留瓣膜的根部重建程序(重塑技术),并通过缝合线瓣环成形术通过主动脉瓣环的外部稳定来完成。经过平稳的干预,患者表现良好,病情得到改善。术后1个月进行的经胸超声心动图检查显示主动脉瓣完全干competent,无反流。
结论:尽管主动脉根和瓣膜完全置换被认为是大型SVA并发主动脉瓣关闭不全的最安全方法,但如果主动脉根未扩张而主动脉瓣未钙化,则不应该忽视瓣膜保留程序。通过应用瓣膜成形术完成的重塑技术进行瓣膜保留术,可减少主动脉瓣膜功能不全,避免与植入瓣膜有关的副作用。

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