Uncorrected Proof Multidiscip Cardio Annal. 2022 July; 13(2):e127396. Published online 2022 November 21. https://doi.org/10.5812/mca-127396. Research Article Surgical Reconstruction of Valsalva Sinus Aneurysms: One Surgical Team Outcomes from Tertiary Center Alireza Alizadeh Ghavidel 1 , Seyyed Sadegh Zargar 1 , Hadi Abo Aljadayel 1, * , Bahador Baharestani 1 , Maziar Gholampour Dehaki 1 and Ziae Totonchi 1 1 Rajaie Cardiovascular Medical and Research Center, Scool of Medicine, Iran University of Medical Sciences, Tehran, Iran * Corresponding author: Rajaie Cardiovascular Medical and Research Center, Scool of Medicine, Iran University of Medical Sciences, Tehran, Iran. Email: hadyaboaljadayel@yahoo.com Received 2022 May 15; Revised 2022 September 28; Accepted 2022 October 17. Abstract Background: There are many surgical methods used to treat sinus of Valsalva aneurysms, and these methods vary depending on the surgical team’s expertise and the patient’s health, which has an impact on the surgical outcomes. Objectives: In our study, we evaluated the midterm outcomes of a single center’s highly skilled surgical team. Methods: In this retrospective cohort study the clinical data of 42 consecutive patients from November 1, 2005 to 21 august 2018 were reviewed and early and mid-term results were assessed. Twenty-two patients (53%) were presented with ruptured aneurysms; 8 of these patients (28.5%) had their aneurysms repaired with a double patch and an AV repair; nonetheless, 20 patients (46.6%) required valve replacement. Results: It was found that there was no bicuspid valve in our patients, no correlation between the presence of VSD and the severity of aortic insufficiency in our series (P = 0.89), and the severity of aortic insufficiency increased when the Valsalva aneurysm ruptured into the heart chambers. There was a strong association between female gender and ruptured sinus of Valsalva aneurysms (P = 0.02, AI severity, P = 0.05, aortic valve surgery, P = 0.03, and total AV replacement, P = 0.001). RSOV and the likelihood of a heart block did not correlate in our series (P = 0. 29). Conclusions: Results from one surgical team, particularly when the same specialist is making decisions, are more trustworthy. Excellent long-term outcomes are obtained, and rupture of the SOV is linked to an increase in AI and, ultimately, to aortic valve surgery, primarily AV replacement. Using patch technique for closing fistulas does not increase the post op arrhythmia. Keywords: Sinus of Valsalva Aneurysm, Aortic Aneurysms, Aortic Root Repair, One Surgical Team, Ruptured Aortic Aneurysms, Cardiac Fistulas. 1. Background Sinus of Valsalva aneurysm (SOVA) is an uncommon cardiac anomaly. It can be congenital or acquired with a prevalence about 0.09% of population (1). It was first re- ported in the literature in the beginning of nineteenth cen- tury (2). It can rupture into the heart’s cavities, most fre- quently extending into the right ventricular outflow tract’s upper portion (3). Congenital SOV aneurysms are usu- ally observed in conjunction with other cardiac anoma- lies such as ventricular septal defect (VSD) or aortic valve dysfunction (4). The transesophageal echocardiography (TEE) is the diagnostic method of choice, in addition to cardiac magnetic resonance and computed tomography (CT) which can be helpful (5). Indications for surgery in non-ruptured SOV aneurysms are symptomatic patients or rapid enlargement. Additionally, untreated ruptured si- nus of Valsalva aneurysm (RSOV) almost always results in worsening of cardiac function. Intervention is therefore required, either by surgery or the use of endovascular clo- sure devices that have successful outcomes (6). 2. Objectives The purpose of the current study was to review the out- comes of 42 patients who underwent surgery to treat sinus Valsalva aneurysms at the university of cardiovascular and research center of Iran during a 12-year period. 3. Methods Approval and Institutional Ethics for this review were obtained from Iran University of medical sciences, we ret- Copyright © 2022, Multidisciplinary Cardiovascular Annals. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.