日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Sinus of Valsalva aneurysm is a rare cardiovascular anomaly that is often asymptomatic and incidentally detected. Early surgical intervention is recommended due to the risk of rupture. In this case, enlargement of the right sinus of Valsalva was identified during postoperative follow-up for aortic coarctation and ventricular septal defect spontaneous closure. The patient was asymptomatic; however, the aneurysm enlarged, requiring surgical intervention. The patient had a bicuspid aortic valve, but the right sinus of Valsalva repair was performed with native aortic valve preservation since aortic stenosis and aortic regurgitation were mild. Considering the risk of reopening a previously closed ventricular septal defect, aneurysmal wall complete resection was avoided. Instead, part of the aneurysmal wall was preserved, and a customized artificial vascular graft (Gelweave, 24 mm) patch was sutured to the inner surface. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. This case demonstrates the feasibility and effectiveness of surgical repair using an artificial vascular graft patch for unruptured, asymptomatic, and enlarging sinus of Valsalva aneurysms. Surgical strategies should be considered according to the anatomical structures, functional status of the aortic root and valves, and pathophysiology of the underlying heart disease in treating the sinus of Valsalva aneurysms.