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Surgery Today Oct 2020A vascular ring is a rare congenital cardiovascular anomaly, which encircles and compresses the trachea or esophagus, or both. In this review we discuss the... (Review)
Review
A vascular ring is a rare congenital cardiovascular anomaly, which encircles and compresses the trachea or esophagus, or both. In this review we discuss the pathophysiology, theoretical embryopathogenesis, diagnostic modalities, and surgical treatment of the different types of vascular ring. Knowledge of the normal embryonic development of the aortic arch and related structures is important for understanding and classifying the various forms of vascular ring. The development of a vascular ring begins with the embryonic aortic arch system. The persistence, involution, or regression of the arches determines the multiple variations of vascular ring. With the development of new technologies, multi-detector computed tomography (MDCT) has become a good diagnostic modality for pre- and postoperative evaluation. MDCT provides an excellent image of aortic arch abnormalities and the related anatomy, as well as the tracheal pathology. For patients with symptoms, surgical division of the vascular ring usually achieves excellent outcomes with marked resolution of symptoms and a low risk of morbidity and mortality. Symptomatic vascular rings require early surgical intervention to prevent prolonged vascular compression of the airway and serious complications.
Topics: Aorta, Thoracic; Deglutition Disorders; Dyspnea; Humans; Multidetector Computed Tomography; Vascular Ring
PubMed: 31676999
DOI: 10.1007/s00595-019-01907-5 -
Seminars in Pediatric Surgery Dec 2021Vascular rings are congenital aortic arch anomalies that lead to compression of the trachea or esophagus. The goal of this review is to summarize our current... (Review)
Review
Vascular rings are congenital aortic arch anomalies that lead to compression of the trachea or esophagus. The goal of this review is to summarize our current recommendations for the management of patients with a diagnosis of a vascular ring. We review the history, classification methods, and epidemiology of the various types of vascular rings. We then propose a management strategy for the relatively new paradigm of fetal diagnosis, including the management of asymptomatic vascular rings. Finally, we finish with a review of the operative techniques and outcomes for the four main categories of vascular rings.
Topics: Aorta, Thoracic; Esophagus; Heart Defects, Congenital; Humans; Subclavian Artery; Vascular Ring
PubMed: 34930596
DOI: 10.1016/j.sempedsurg.2021.151128 -
The Journal of Thoracic and... Jul 2022Although most children do well after operations to relieve vascular compression of the esophagus and airway, many will have persistent/recurrent symptoms. We review our... (Review)
Review
OBJECTIVE
Although most children do well after operations to relieve vascular compression of the esophagus and airway, many will have persistent/recurrent symptoms. We review our surgical experience using a customized approach to correct various etiologies of failure after vascular ring/decompression surgery.
METHODS
Our institutional database identified children who underwent reoperation for persistent/recurrent symptoms after vascular ring or aberrant arterial decompression surgery between January 2014 and December 2019. Charts were reviewed for operative approaches and clinical data. Findings were analyzed by Fisher exact test for comparison between groups.
RESULTS
Twenty-seven children required reoperative surgery. Detailed preoperative workup identified 5 etiologies of failure for a customized approach. Residual scarring was corrected by lysis and rotational esophagoplasty (n = 23/27); fibrotic bands re-creating a ring were divided (n = 11); ongoing vascular compression was addressed by descending aortopexy (n = 19), aberrant subclavian division (n = 7), aortic uncrossing procedure (n = 4), and Kommerell resection (n = 8); anterior aortopexy (n = 6) and anterior tracheopexy (n = 9) corrected cartilage malformation; and tracheobronchomalacia was addressed with posterior airway pexy (n = 26). At available short-term follow-up (median 1 year), 21 of 22 patients (95%) had symptom improvement, and on bronchoscopy, the average number of airway sections with severe tracheobronchomalacia decreased from 2.8 ± 1.7 to 0.5 ± 0.9 (P < .001).
CONCLUSIONS
Persistent/recurrent symptoms after release of vascular compression are frequently caused by 5 different etiologies. A multidisciplinary strategy for workup and a customized operative approach can effectively treat these cases and may suggest opportunity at the index surgery to prevent reoperation and achieve optimal outcomes.
Topics: Child; Decompression; Humans; Reoperation; Retrospective Studies; Tracheobronchomalacia; Vascular Ring
PubMed: 34922756
DOI: 10.1016/j.jtcvs.2021.08.089 -
Cureus Apr 2022Vascular rings are congenital abnormalities of the aortic arch vascular system that compress the trachea and esophagus. A review of long-term outcomes suggests that... (Review)
Review
Vascular rings are congenital abnormalities of the aortic arch vascular system that compress the trachea and esophagus. A review of long-term outcomes suggests that chronic feeding difficulties can persist following surgical repair of vascular rings. Previous reports of postoperative vascular ring division outcomes indicate that chronic esophageal symptoms may persist following repair, though most available data focuses on persistent respiratory symptoms. It is therefore the aim of this article to summarize and organize recent evidence reporting the frequency, presentation, and management of feeding difficulties following vascular ring repair in pediatric patients. Pathophysiologic mechanisms for postoperative esophageal symptoms may include residual compression from an unresected diverticulum of Kommerell or delayed repair leading to chronic esophageal dysmotility despite correction of esophageal compression. Guidance on the management of feeding difficulties following vascular ring repair is limited. The authors describe success in one case with nasogastric tube feeding and interdisciplinary evaluation. Consensus regarding the management of feeding difficulty following vascular ring repair is needed.
PubMed: 35651405
DOI: 10.7759/cureus.24623 -
The Journal of Thoracic and... Jul 2022
Topics: Humans; Mitral Valve Insufficiency; Treatment Outcome; Vascular Ring; Vascular Surgical Procedures
PubMed: 34548156
DOI: 10.1016/j.jtcvs.2021.08.070 -
European Journal of Cardio-thoracic... May 2022
Topics: Child; Diverticulum; Female; Humans; Pregnancy; Prenatal Diagnosis; Subclavian Artery; Treatment Outcome; Vascular Ring
PubMed: 35024831
DOI: 10.1093/ejcts/ezac007 -
Indian Journal of Pediatrics Dec 2023
Topics: Humans; Vascular Ring; Breath Holding; Cyanosis
PubMed: 37477861
DOI: 10.1007/s12098-023-04760-0 -
European Journal of Cardio-thoracic... Jun 2022
Topics: Aorta, Thoracic; Decision Trees; Diverticulum; Humans; Subclavian Artery; Vascular Ring
PubMed: 34894130
DOI: 10.1093/ejcts/ezab525 -
Pediatric Cardiology Aug 2023We present the clinical course and echocardiographic and genetic findings of two fetuses with an unusual vascular ring, created by a left aortic arch with a right...
We present the clinical course and echocardiographic and genetic findings of two fetuses with an unusual vascular ring, created by a left aortic arch with a right arterial duct and an aberrant right subclavian artery. One fetus was diagnosed with 22q11.2 microdeletion and the other became symptomatic in infancy. It is important to consider the position of the arterial ductal ligament in patients who present with tracheoesophageal compressive symptoms in the presence of a left aortic arch. These cases also highlight that a vascular ring formed from a left arch may have similar associations to a vascular ring formed by a right aortic arch.
PubMed: 37566242
DOI: 10.1007/s00246-023-03261-3