-
Ultraschall in Der Medizin (Stuttgart,... Dec 2022Congenital aortic vascular ring may present after birth with variable degrees of respiratory distress due to tracheal compression. The aim of this study was to...
OBJECTIVE
Congenital aortic vascular ring may present after birth with variable degrees of respiratory distress due to tracheal compression. The aim of this study was to prospectively evaluate in utero tracheal patency in correlation with postnatal outcome.
METHODS
During an eight-year period, fetuses with aortic arch abnormality encircling the trachea and forming a complete ring were recruited for the study. Tracheal patency was classified as: no compression, partial compression, or complete compression. Postnatal MRI/CTangio studies were performed and outcome data was retrospectively analyzed from the medical records.
RESULTS
Among the 46 fetuses recruited to the study, 38 had right aortic arch (RAA), and 8 presented with double aortic arch (DAA). In the RAA group 35 (92.1 %) of the fetuses presented no compression and 34 (97.1 %) of them were asymptomatic in the long-term follow-up. Three fetuses (7.9 %) in this group presented in utero compression: one was terminated at 16 weeks of gestation due to associated ominous findings, and the other two had mild respiratory symptoms around 12 months of age and underwent surgery with a good outcome. In the DAA group, all fetuses presented in utero with tracheal compression. Seven showed partial and one complete compression. Among the seven with partial compression, six were symptomatic and underwent surgery. The case with severe airway occlusion had emergency tube insertion in the delivery room and underwent surgery at 7 days but died from severe respiratory complications.
CONCLUSION
This is the first study to evaluate in utero tracheal patency in cases with vascular ring. It allows better prenatal and postnatal workup and follow-up including potentially life-threatening respiratory failure.
Topics: Pregnancy; Female; Humans; Vascular Ring; Trachea; Retrospective Studies; Aorta, Thoracic; Ultrasonography, Prenatal; Lung Diseases
PubMed: 33091939
DOI: 10.1055/a-1283-6051 -
Journal of Pediatric Surgery Oct 2018Vascular ring is a rare cause of recurrent respiratory infections, dysphagia and stridor. Surgical repair is considered safe but the long-term outcomes are unclear. The...
BACKGROUND
Vascular ring is a rare cause of recurrent respiratory infections, dysphagia and stridor. Surgical repair is considered safe but the long-term outcomes are unclear. The purpose of this study was to investigate the mortality and morbidity following vascular ring surgery in a single institution.
MATERIALS AND METHODS
This retrospective study covers operations done at Aarhus University Hospital, Denmark between October 1983 and May 2015. Medical records were reviewed focusing on early complications and long-term complaints up to September 2017.
RESULTS
A total of 23 patients with median age of 1.4 years (range 0.008-64 years) were operated for vascular ring. Median follow-up was 6.8 years (range 2.4-34 years). Presenting symptoms were stridor (52%), dysphagia or vomiting (52%) and recurrent respiratory infections (48%). There were no early or late deaths. Three months postoperatively, 59% reported no respiratory complaints and 50% reported normal eating habits. Long term, only 14% had no complaints. In particular, asthma (36%), persistent stridor (18%) and recurrent respiratory infections (32%) were frequent. A high number of patients developed mental illness (27%).
CONCLUSION
Surgery for vascular ring can be performed with low early and long-term mortality. Despite good three months outcome, the majority of patients had long-term respiratory issues. Oesophageal morbidity was low.
LEVEL-OF-EVIDENCE
2B.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Denmark; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Middle Aged; Morbidity; Postoperative Complications; Retrospective Studies; Treatment Outcome; Vascular Ring; Vascular Surgical Procedures; Young Adult
PubMed: 29402450
DOI: 10.1016/j.jpedsurg.2017.12.022 -
Pediatric Radiology Sep 2022Compression of the airway, esophagus or both by aortic and pulmonary vessels can be caused by a variety of anatomical situations. Vascular rings are the most commonly... (Review)
Review
Compression of the airway, esophagus or both by aortic and pulmonary vessels can be caused by a variety of anatomical situations. Vascular rings are the most commonly encountered entity; however, compression can also occur from less common anomalies such as a left pulmonary artery sling or innominate artery compression. Vascular rings and other vascular compression abnormalities can be challenging to visualize and image and often require advanced imaging by CT or MRI to better understand the cause and extent of compression. Atretic vascular structures, such as the ligamentum arteriosum or atretic arch, play a key role in creating a vascular ring and do not enhance with contrast agent in a typical fashion. Despite these imaging challenges, classic and useful signs can indicate the presence or absence of a vascular ring or compression.
Topics: Aorta, Thoracic; Humans; Infant; Magnetic Resonance Imaging; Subclavian Artery; Tomography, X-Ray Computed; Vascular Malformations; Vascular Ring
PubMed: 35438331
DOI: 10.1007/s00247-022-05366-y -
Archives of Disease in Childhood.... Jun 2015Upper airway obstruction (UAO) in infants and children has a broad spectrum of presentations including benign self-resolving conditions, from mild croup, to critical... (Review)
Review
Upper airway obstruction (UAO) in infants and children has a broad spectrum of presentations including benign self-resolving conditions, from mild croup, to critical life-threatening conditions which, though uncommon now, require prompt recognition and effective multidisciplinary collaborative management to achieve a good outcome. The aim of this article is to highlight the diagnostic and management difficulties in acute UAO in paediatric patients and encourage a problem-solving approach.
Topics: Airway Obstruction; Child; Female; Humans; Infant; Infant, Newborn; Male; Respiratory Sounds
PubMed: 25035313
DOI: 10.1136/archdischild-2013-304604 -
Pharmaceutical Biology Dec 2023Gastrodin has been used as antihypertension therapy in China; however, the mechanisms underlying the effects of gastrodin have yet to be fully elucidated.
CONTEXT
Gastrodin has been used as antihypertension therapy in China; however, the mechanisms underlying the effects of gastrodin have yet to be fully elucidated.
OBJECTIVE
To explore the therapeutic efficiency of gastrodin as an antihypertensive and determine the mechanisms underlying this effect.
MATERIALS AND METHODS
C57BL/6 mice were continuously administered angiotensin II (Ang II) (500 ng/kg/min) to induce hypertension. Mice were randomly divided into control, Ang II and Ang II + gastrodin groups. Mice received intragastric administration of gastrodin (5 mg/kg) or double distilled water once a day for 4 weeks. Blood pressure, pulse wave velocity (PWV), thickness of the abdominal aorta, pathological morphology and differential expression transcripts (DETs) were assessed. Abdominal aorta rings and primary isolated vascular smooth muscle cells were subjected to Ang II stimulation to induce hypertension as and models, respectively. Vascular ring tension, release of Ca and levels of proteins involved in the myosin light chain kinase (MLCK)/phospho-myosin light chain 2 (p-MLC) pathway were determined.
RESULTS
Gastrodin treatment attenuated increases in blood pressure, PWV and thickness of the abdominal aorta. Treatment with gastrodin resulted in 2785 DETs and the enrichment of vascular contraction and calcium signalling pathways. Gastrodin treatment attenuated Ang II-induced vasoconstriction, produced a norepinephrine-precontracted vasodilation effect (attenuated by verapamil), and reduced intracellular Ca release. Furthermore, gastrodin suppressed activation of the MLCK/p-MLC pathway and .
CONCLUSIONS
Gastrodin treatment lowers blood pressure, suppresses Ang II-induced vascular contraction and MLCK/p-MLC pathway activation, thereby demonstrating the mechanisms underlying the therapeutic efficacy of gastrodin as an antihypertensive.
Topics: Animals; Mice; Angiotensin II; Antihypertensive Agents; Hypertension; Mice, Inbred C57BL; Muscle, Smooth, Vascular; Pulse Wave Analysis
PubMed: 37211627
DOI: 10.1080/13880209.2023.2207591 -
Annals of Pediatric Cardiology 2021Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan...
BACKGROUND
Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan surgery after birth.
OBJECTIVES
The purpose of the study was to see the feasibility of accurate diagnosis of VR during antenatal ultrasound examination and describe their outcome.
METHODS
This is a retrospective observational study between January 2014 and December 2019. Vascular rings were diagnosed on the basis of three vessel tracheal view and neck vessels arrangements on fetal echocardiogram. Postnatal evaluation by transthoracic echocardiography and computerized tomography angiogram was performed. Surgical repair was done as per standard indications.
RESULTS
A total of 35 cases of fetal VRs (median gestational age: 24 weeks [range: 19-35]) were diagnosed during the study period. There were four dichorionic diamniotic twin gestation pregnancies. The right aortic arch (RAA) with anomalous left subclavian artery (ALSA) was suspected in 31 fetuses, double aortic arch (DAA) in 3, and circumflex aorta in 1. Twenty-six (74%) patients had successful deliveries. One patient had a spontaneous miscarriage, 2 underwent termination, and 6 were lost to follow-up. Postnatal assessment showed RAA with ALSA in 18, DAA in 5, circumflex aorta in 2, and no abnormality in 1. Twenty-two (86%) were operated (RAA with ALSA: 17, DAA: 4, and circumflex aorta: 1) and four were waiting for surgery. Two patients died due to prematurity-related complications. All survivors are symptom free during follow-up (median: 2.24; range: 0.2-5.6 years).
CONCLUSIONS
Fetal echocardiography enables prenatal diagnosis and planning of postnatal repair of VRs.
PubMed: 34667409
DOI: 10.4103/apc.APC_108_20 -
Seminars in Cardiothoracic and Vascular... Feb 2024Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict... (Review)
Review
Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.
PubMed: 38379198
DOI: 10.1177/10892532241234404 -
Seminars in Fetal & Neonatal Medicine Aug 2018The ductus arteriosus (DA) is a crucial part of the fetal circulation, both in the normal fetus and in critical congenital heart disease (CHD). It allows shunting... (Review)
Review
The ductus arteriosus (DA) is a crucial part of the fetal circulation, both in the normal fetus and in critical congenital heart disease (CHD). It allows shunting between the pulmonary and systemic circulations. In physiological prenatal conditions, the DA lets the majority of right ventricular output bypass the fluid-filled, high-resistance lungs. The DA can cause hemodynamic compromise in the fetus and neonate when constricted or absent (in isolation or in patients with CHD) and may lead to pre- or postnatal sequelae within other systems when forming part of a vascular ring. In CHD, the DA can be interrogated by fetal echocardiography to infer information regarding severity of pulmonary outflow tract obstruction, adequacy of the sub-pulmonary ventricle to supply pulmonary blood flow, and to predict the likelihood of atrial septum restriction in transposition of the great arteries. A good understanding of the DA is crucial for fetal cardiologists.
Topics: Ductus Arteriosus; Echocardiography; Female; Fetal Heart; Hemodynamics; Humans; Infant, Newborn; Pregnancy; Ultrasonography, Prenatal
PubMed: 29530740
DOI: 10.1016/j.siny.2018.03.001 -
The Veterinary Clinics of North... Jan 2016Video-assisted thoracic surgery (VATS) is an evolving modality in the treatment and management of a variety of pathologies affecting dogs and cats. Representative... (Review)
Review
Video-assisted thoracic surgery (VATS) is an evolving modality in the treatment and management of a variety of pathologies affecting dogs and cats. Representative disease processes include pericardial effusion, pericardial neoplasia, cranial mediastinal neoplasia, vascular ring anomaly, pulmonary neoplasia, pulmonary blebs and bullae, spontaneous pneumothorax, and chylothorax. Several descriptive and small case reports have been published on the use of VATS in veterinary medicine. More recently, larger case series and experimental studies have revealed potential benefits and limitations not documented previously. Significant technological advances over the past 5 years have made possible a host of new applications in VATS. This article focuses on updates and cutting-edge applications in VATS.
Topics: Animals; Cats; Dogs; Thoracic Surgery, Video-Assisted
PubMed: 26410560
DOI: 10.1016/j.cvsm.2015.07.005 -
Indian Journal of Pediatrics Dec 2023
Topics: Humans; Vascular Ring; Breath Holding; Cyanosis
PubMed: 37477861
DOI: 10.1007/s12098-023-04760-0