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J Thorac Cardiovasc Surg. 2013 Oct;146(4):874-8. doi: 10.1016/j.jtcvs.2012.12.059. Epub 2013 Jan 11.

Modified Sakakibara classification system for ruptured sinus of Valsalva aneurysm.

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Department of Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:



To introduce a modified Sakakibara classification system for a ruptured sinus of Valsalva aneurysm.


From February 1, 2006, to January 31, 2012, surgical repair was performed on 159 patients with a ruptured sinus of Valsalva aneurysm at Fu Wai Hospital. Of the 159 patients, 105 were men and 54 were women, with a mean age of 33.4 ± 10.7 years. The patients were divided into 5 types according to the site of the ruptured sinus of Valsalva aneurysm rupture. The 5 types were as follows: type I, rupture into the right ventricle just beneath the pulmonary valve (n = 66); type II, rupture into or just beneath the crista supraventricularis of the right ventricle (n = 17); type III, rupture into the right atrium (type IIIa, n = 21) or right ventricle (type IIIv, n = 6) near or at the tricuspid annulus; type IV, rupture into the right atrium (n = 46); and type V, other rare conditions, such as rupture into the left atrium, left ventricle, or pulmonary artery (n = 3).


Repair of ruptured sinus of Valsalva aneurysm through aortotomy was used in 100% of those with type V and 50% of those with type IIIv. In most patients with types I, II, and IV, repair was achieved through the cardiac chamber of the fistula exit (71.2%, 64.7%, and 69.6%, respectively). Both routes of repair were used in 76.2% of patients with type IIIa. No early and late deaths occurred. The aortic valve was replaced in 33 patients. One patient (type IV) underwent reoperation for a residual shunt during the follow-up period.


The modified classification system for ruptured sinus of Valsalva aneurysm is simple and practical for clinical use.


20; CPB; RSVA; VSD; cardiopulmonary bypass; ruptured sinus of Valsalva aneurysm; ventricular septal defect

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