OBJECTIVETo compare the safety, feasibility, and efficacy of a completely nonfluoroscopic approach to radiofrequency catheter ablation (RFCA) using CARTO3 and ablation with conventional fluoroscopic guidance for treatment of idiopathic premature ventricular contractions from the aortic sinus cusp (ASC-PVCs).

METHODSFrom April 2013 to October 2015, we prospectively enrolled 52 consecutive patients with ASC-PVCs scheduled for either CARTO3 mapping-guided zero-fluoroscopy ablation (group A, n=23) or conventional fluoroscopic ablation (group B, n=29). The success rates, rates of complications, rates of recurrences, number of radiofrequency applications, procedure time, mapping time and fluoroscopy time were compared between the 2 groups.

RESULTSs No significant differences were found in the success rates between the 2 groups [22/23 (96%) vs 24/29 (83%), P=0.21]. No major complications occurred during the procedures in either group. There was no significant difference with regard to the procedure time between the two groups (79.6∓8.8 vs 77.4∓7.2 min, P=0.332). The procedure was completed without any fluoroscopy use in group A, while the mean fluoroscopy time in group B was 23.1∓6.0 min. Group A showed a shorter mapping time than group B (4.3∓1.7 vs 7.8∓2.6 min, P<0.01) with significantly fewer radiofrequency applications (4.8∓1.1 vs 7.9∓3.2, P<0.01). The recurrence rates were comparable between the two groups over a follow-up period of 5 to 20 months.

CONCLUSIONCompared with the conventional fluoroscopic technique, the zero-fluoroscopy approach can shorten the total procedure time and the ablation time with significantly reduced RF applications to eliminate ionizing radiation exposure in RFCA. RFCA guided by CARTO3 system without fluoroscopy is feasible, safe, and effective for treatment of ASC-PVCs.

Catheter Ablation ; Fluoroscopy ; Humans ; Radio Waves ; Recurrence ; Sinus of Valsalva ; physiopathology ; Treatment Outcome ; Ventricular Premature Complexes ; surgery

Adult ; Aortic Rupture ; surgery ; therapy ; Humans ; Male ; Septal Occluder Device ; Sinus of Valsalva ; surgery ; Young Adult

BACKGROUNDSinus of Valsalva aneurysm (SVA) is a rare anomaly and few large or long-term series are well established. This study was designed to review 33-year surgical experience of SVA in one center.

METHODSFrom August 1980 to December 2013, patients with SVA underwent surgical repair were retrospectively studied.

RESULTSA total of 160 patients were identified with mean age of (30±12) years and 112 (70%) of them were males. The right coronary sinus origin of SVA was found in 108 patients (67.5%), the non-coronary sinus in 51 patients (31.9%), and the left coronary sinus in one patient (0.6%). The rupture of SVA into the right ventricle was identified in 89 (55.6%) cases, the right atrium in 61 (38.1%), the left ventricle in 2 (1.3%) and no rupture in 8 (5.0%). Ventricular septal defect (VSD) and aortic regurgitation (AR) were found in 59 (37%) and 45 (28%) patients respectively. An approach via the involved chamber was used in 86 patients (54%), aortotomy in 8 (5%), and a combined approach in 66 (41%). Either direct suture (56, 35%) or patch (104, 65%) closure were used to repair the SVA. The VSD was closed with a patch (44/59, 75%) or direct suture (15/59, 25%). aortic valve replacement (AVR) was performed in 23/45 (51%) and aortic valvuloplasty (AVP) in 9/45 (20%) patients combined with AR. There were 3 hospital deaths (1.9%) and 2 late deaths and 84% of the patients were followed up for (17.6±4.2) years. New York Heart Association functional class improved significantly after surgery (P < 0.01). Actuarial survival was 94% at 10 years, and 88% at 20 years.

CONCLUSIONSSurgical treatment of SVA is safe and effective, ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as possible. However, late progressive AR is still a risk during long-term follow-up, and early aggressive measures are recommended. These include more use of a combined approach to achieve optimal evaluation of lesions, more patch repairs to reduce the chance of recurrence, and more AVR in patients with moderate to severe AR.

Adolescent ; Adult ; Aortic Aneurysm ; surgery ; Cardiac Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sinus of Valsalva ; surgery ; Young Adult

BACKGROUNDSinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results.

METHODSBetween January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was (33.71 ± 13.25) years (range 16 - 52 years). Associated cardiovascular lesions were aortic regurgitation (n = 7), ventricular septal defect (n = 5), coarctation of aorta (n = 1), bicuspid aortic valve (n = 1), patent ductus arteriosus (n = 1), and aortic valve stenosis (n = 1). The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months (mean (63.14 ± 39.54) months). Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively.

RESULTSThere was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association (NYHA) functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%, 46.15%, and 2.99%, respectively.

CONCLUSIONSSurgical repair of SVA with discrete membranous subaortic stenosis showed good mid-term results. Resection of discrete subaortic membrane should be done actively while repairing SVAs. Long-term results need to be followed up.

Adolescent ; Adult ; Discrete Subaortic Stenosis ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Sinus of Valsalva ; pathology ; surgery ; Treatment Outcome ; Young Adult

BACKGROUNDIn the 21st century, minimally invasive treatment is one of the main developmental directions of medical sciences. It is well known that the echocardiography plays an important role during interventional treatments of some structural heart diseases. Because the ruptured right sinus of the Valsalva aneurysm (RRSVA) is a rare disease, there were few reports about percutaneous catheter closure of RRSVA. This study aimed to sum up our experience with transthoracic echocardiography (TTE) during percutaneous catheter closure of RRSVA.

METHODSFive RRSVA cases were treated with percutaneous catheter closure. The whole procedure was guided and monitored by TTE and fluoroscopy. The maximum diameter of the RRSVA was measured by TTE before and after the catheter passed through the rupture site. A duct occluder 2 mm larger than the maximum diameter was chosen. The closure effects were evaluated with TTE and fluoroscopy immediately after the occluding device was deployed. All patients were followed up by TTE for 8 to 30 months.

RESULTSBefore the catheter passed through the rupture site the maximum diameter of the RRSVA measured with TTE and aortography were (7.9 ± 2.1) mm and (7.8 ± 1.8) mm. After the catheter passed through the rupture site the maximum diameter measured with TTE was (11.2 ± 3.2) mm, which was significantly larger than before the procedure (P < 0.05). The percutaneous catheter closure was successful in four cases and failed in one. Compared to the aortography the TTE was better at distinguishing residual shunts from aortic valve regurgitation immediately after the occluding device was deployed. There were no complications during 8 to 30 months of follow-up.

CONCLUSIONTransthoracic echocardiography can play an important role during percutaneous catheter closure of RRSVA, especially for estimating the size of the RRSVA after the catheter passes through the rupture site, and differentiating residual shunt from aortic valve regurgitation immediately after the occluding device is deployed.

Adult ; Echocardiography ; methods ; Female ; Humans ; Male ; Middle Aged ; Sinus of Valsalva ; diagnostic imaging ; surgery

OBJECTIVESTo summarize the experience of surgical repair of ruptured sinus of Valsalva aneurysm to right atrium and to compare the difference between through right atrium repair and transaortic combined with right atrium approach.

METHODSBetween January 2004 and December 2009, 53 patients with ruptured sinus of Valsalva aneurysm to right atrium underwent surgical repair. There were 35 male and 18 female, aged from 15 to 63 with a mean of (33 ± 9) years. Repair through right atrium had undergone in 40 patients (group I), while transaortic combined with right atrium approach in 13 patients (group II). Surgical results between the two group and group were compared in cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, ICU time and postoperative stay time.

RESULTSThere were no significant differences between two groups in cardiopulmonary bypass time [(86 ± 29) min vs. (96 ± 30) min], clamp aorta time [(59 ± 29) min vs. (71 ± 25) min], mechanical ventilation time [(9 ± 4) h vs. (16 ± 23) h], ICU time [(35 ± 23) h vs. (35 ± 23) h], postoperative stay time [(7.1 ± 0.9) d vs. (7.7 ± 2.8) d] (P > 0.05). Follow-up was performed from 1 to 64 months, with a mean of (32 ± 21) months. There was no death during follow up. One needed operation due to severe aortic valve regurgitation. One combined with coronary artery disease used medication. Heart function (NYHF) of the other patients were I and II degree during follow up.

CONCLUSIONSSurgical repair of ruptured sinus of Valsalva aneurysm to right atrium shows good result. There is no significant difference between through right atrium repair and transaortic combined with right atrium approach.

Adolescent ; Adult ; Aorta ; surgery ; Aortic Rupture ; surgery ; Female ; Follow-Up Studies ; Heart Atria ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sinus of Valsalva ; Treatment Outcome ; Young Adult

OBJECTIVETo summarize the clinic characteristics and effect of surgical repair of ruptured aortic sinus aneurysm.

METHODSFrom September 1997 to September 2007, 43 patients with ruptured aortic sinus aneurysm underwent surgical procedures. There were 32 male and 11 female patients. The age ranged from 11 to 50 years old with a mean of (29.0 +/- 11.5) years old. The origins of rupture were the right coronary sinus in 34 patients and the noncoronary sinus in 9 patients. The aneurysms ruptured into the right ventricle in 30 patients, the right atrium in 8 patients, the right ventricle and right atrium in 3 patients, and the ventricular septum and then the right ventricle in 2 patients. Associated cardiac anomalies included ventricular septal defect in 26 patients, aortic regurgitation in 15 patients, infectious endocarditis in 8 patients, tricuspid regurgitation in 6 patients, atrial septum defect in 4 patients, mitral valve regurgitation in 2 patients, patent ductus arteriosus in 2 patients, and pulmonary valve vegetation in 1 patient. All the patients underwent the repair of ruptured aortic sinus aneurysm and correction of associated anomalies with cardiopulmonary bypass.

RESULTSThere were no deaths after the operation and during the follow-up. The complications, including acute heart failure and III atrioventricular block, occurred in 5 patients. Follow-up was 6 to 120 months with a mean of (68.0 +/- 17.7) months. Two patients underwent reoperation for aortic valve replacement at the 6(th) and 8(th) year after the first operation. There were 2 patients which the aortic regurgitation deteriorated from grade I to II.

CONCLUSIONSRepair of ruptured aortic sinus aneurysm presents a satisfactory result. Aggressive treatment in early time, prevention of post-operative complications and long-term follow-up are recommended in the treatment for patients of ruptured aortic sinus aneurysm with infectious endocarditis and aortic regurgitation.

Adolescent ; Adult ; Aortic Rupture ; surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sinus of Valsalva ; surgery ; Treatment Outcome

This report describes the case of a 45-year-old Korean female who had suffered from Behcet's syndrome for two years with a huge, unruptured aneurysm originating from the left coronary sinus. The aneurysm had caused myocardial and aortic insufficiency by compressing the proximal left anterior descending coronary artery. The orifice of the aneurysm was at the left coronary sinus, about 5mm from the left main coronary ostium, and it was filled with organized thrombi. Surgical repair was performed by closing the entrance of the aneurysm with a Dacron patch and by implementing aortic valve repair and coronary artery bypass grafting. The patient's coronary flow was restored postoperatively, and all anginal symptoms disappeared.
Aortic Aneurysm/*complications/radiography/surgery ; Behcet Syndrome/*complications ; Coronary Artery Bypass ; Female ; Humans ; Middle Aged ; Myocardial Infarction/*etiology ; *Sinus of Valsalva/surgery ; Tomography, X-Ray Computed

Adult ; Aortic Aneurysm ; surgery ; Aortic Rupture ; surgery ; Budd-Chiari Syndrome ; therapy ; Heart Atria ; injuries ; Humans ; Male ; Sinus of Valsalva ; Stents ; adverse effects

BACKGROUND: It is very important to determine the surgical anatomy of the aortic root when performing spreading aortic root preserving heart surgery. This study focuses on the surgical aspect of the aortic root anatomy by performing dissection of Korean cadavers. MATERIAL AND METHOD: The subjects were 62 cadavers. We measured the intercommissural distances, heights of the sinuses and the circumference of the sinotubular junction and the aortic annulus. RESULT: The mean age of death was 61.3 years. The intercommissural distance for the right coronary sinus was 0.73+/-2.23 mm, that for the non coronary sinus was 19.34+/-2.03 mm, and that for the left coronary sinus was 18.58+/-2.15 mm. The height of sinus was 20.59+/-2.48 mm for the right coronary sinus, 18.61+/-2.26 mm for the non coronary sinus and 17.95+/-19 mm for the left coronary sinus. The circumference of the sinotubular junction was 70.73+/-5.94 mm and that of the aortic annulus was 77.94+/-5.63 mm. There is no correlation between age and STJ, aortic annulus and the ratio of STJ of aortic annulus respectively (p=0.920, p=0.111, p=0.073). The tilting angle of the sinotubular junction and aortic annulus is from 2.03 degrees to 7.77 degrees (mean=4.90 degrees). CONCLUSION: The intercommissural distance and the height of the sinus were largest in the right coronary sinus, and the position of the sinotubular junction to the aortic annulus is obliquely tilted levo-posteriorly.
Aortic Valve ; Cadaver ; Coronary Sinus ; Sinus of Valsalva ; Thoracic Surgery