Totally endoscopic patch repair for ruptured sinus of Valsalva aneurysm associated with ventricular septal defect

Ruptured sinus of Valsalva aneurysm (RSVA) associated with ventricular septal defect (VSD) is a rare but clinically significant condition requiring surgical intervention. We report two cases of RSVA with concomitant infundibular VSD successfully treated using a totally endoscopic approach through an aortotomy alone. Both patients were young adults presenting with heart failure symptoms caused by left-to-right shunting. Patch repair of the sinus of Valsalva aneurysm and VSD closure were performed under totally endoscopic visualization. Postoperative echocardiography showed no residual shunt. Both patients were discharged uneventfully. Mild aortic regurgitation was observed but remained stable during mid-term follow-up. Totally endoscopic repair of RSVA associated with VSD could be a feasible option.