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Veterinary Surgery : VS Feb 2020To report the clinical characteristics, types of vascular ring anomalies (VRA), operative findings, complications, and survival after surgical treatment of cats with VRA.
OBJECTIVE
To report the clinical characteristics, types of vascular ring anomalies (VRA), operative findings, complications, and survival after surgical treatment of cats with VRA.
STUDY DESIGN
Retrospective, multi-institutional case series.
ANIMALS
Client- or shelter-owned cats presenting to academic, referral veterinary institutions.
METHODS
Medical records of cats with VRA that underwent surgical treatment were reviewed. Signalment, relevant medical history, clinical signs, diagnostic imaging, surgical findings, complications, and survival were recorded.
RESULTS
Twenty cats with VRA were included. Vascular ring anomalies were most commonly (75% [15/20]) diagnosed in cats less than 1 year old, with no breed or sex predilection. Regurgitation was the most common clinical sign, present in 18 of 20 (90%) cats. A persistent right aortic arch was diagnosed in 17 of 20 (85%) cats, with concurrent aberrant left subclavian artery in four of the cats. Surgical treatment was associated with survival to discharge in 18 of 20 (90%) cats. Persistent clinical signs were reported in nine of 13 (69%) cats, and radiographic evidence of megaesophagus persisted in four of 13 (31%) cats, with a median follow-up of 275 days after discharge.
CONCLUSION
Persistent right aortic arch was the most commonly diagnosed VRA in cats in this series, although multiple anomalies were observed. Surgical treatment of VRA in cats was associated with a high survival to discharge, although persistence of clinical signs and megaesophagus was noted in 69% and 31% of the cats, respectively.
CLINICAL SIGNIFICANCE
Surgical treatment of VRA in cats is associated with a high survival rate; however, persistence of clinical signs is an expected outcome.
Topics: Abnormalities, Multiple; Animals; Cardiovascular Abnormalities; Cat Diseases; Cats; Female; Male; Retrospective Studies; Subclavian Artery; Vascular Ring
PubMed: 31598999
DOI: 10.1111/vsu.13327 -
Journal of Pediatric Surgery Nov 2020Vascular rings are often diagnosed after evaluation for swallowing and breathing difficulties. Data regarding symptoms following vascular ring repair is sparse. We...
PURPOSE
Vascular rings are often diagnosed after evaluation for swallowing and breathing difficulties. Data regarding symptoms following vascular ring repair is sparse. We sought to determine whether symptoms persist using chart review and a survey.
METHODS
Sixty-three patients underwent open vascular ring repair from July 2007 to May 2018. Data regarding vascular anatomy, demographics, pre- and postoperative symptoms, and chromosomal abnormalities were collected. Freedom from reoperation, 30-day mortality, and complications were assessed. Patient families were contacted for a symptom focused survey.
RESULTS
The median age of surgical intervention was 14.4 months (IQR 5.8-34.7 months) for single aortic arches with an aberrant subclavian artery (SAA), and 5.3 months (IQR 1.3-10.1 months) for double aortic arches (DAA) (Table). Prior to surgery, all but two SAA were symptomatic. There was no operative mortality. Three patients required re-exploration for chylothorax, and three required late aortopexy. At last follow-up, 45% (18/40) SAA and 65% (15/23) DAA had post-operative symptoms. Fourteen patient families completed the symptom survey (10 SAA, 4 DAA). Five SAA had breathing and swallowing symptoms, and 3 SAA and 3 DAA had breathing difficulties.
CONCLUSIONS
Open vascular ring repair remains a safe repair. However, further investigation of the persistent symptoms in these patients is merited.
STUDY TYPE / LEVEL OF EVIDENCE
Retrospective Comparative Study, Level III.
Topics: Aorta, Thoracic; Child, Preschool; Deglutition Disorders; Humans; Infant; Respiration; Respiratory Tract Diseases; Retrospective Studies; Subclavian Artery; Treatment Outcome; Vascular Ring
PubMed: 32005503
DOI: 10.1016/j.jpedsurg.2019.12.022 -
Head & Neck 1989Congenital vascular ring anomalies frequently present to the pediatric otolaryngologist with symptoms of tracheoesophageal compression. One such case is reported and the...
Congenital vascular ring anomalies frequently present to the pediatric otolaryngologist with symptoms of tracheoesophageal compression. One such case is reported and the literature reviewed. The role of the otolaryngologist in the diagnosis and management of congenital vascular ring anomalies is discussed.
Topics: Aorta, Thoracic; Esophageal Stenosis; Humans; Infant; Male; Tracheal Stenosis
PubMed: 2722493
DOI: 10.1002/hed.2880110211 -
The Journal of Thoracic and... Sep 2020
Topics: Aorta; Aorta, Thoracic; Humans; Tracheobronchomalacia; Vascular Ring
PubMed: 32381335
DOI: 10.1016/j.jtcvs.2020.03.125 -
Radiology Case Reports Mar 2023In this paper, we describe a rare case of double aortic arch with dominant right arch with focal narrowing of the distal left arch and descendent aorta's dilatation,...
In this paper, we describe a rare case of double aortic arch with dominant right arch with focal narrowing of the distal left arch and descendent aorta's dilatation, associated with pulmonary embolism and left subclavian steal syndrome, found in a 59-year-old woman with a history of dysphagia, chest discomfort, and left arm claudication. Diagnosis of this condition was made with a sub-optimal pulmonary CT-angiography with a combination of characteristic features of double aortic arch and vascular rings. Being aware of these conditions is crucial to avoid misclassification and surgical and endovascular complications.
PubMed: 36636482
DOI: 10.1016/j.radcr.2022.11.040 -
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 -
Ryoikibetsu Shokogun Shirizu 1996
Review
Topics: Aorta, Thoracic; Aortic Diseases; Diagnosis, Differential; Humans
PubMed: 9117737
DOI: No ID Found -
European Journal of Cardio-thoracic... Feb 2022Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of...
OBJECTIVES
Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of patients with vascular ring division.
METHODS
A multi-institution retrospective review of 371 patients with vascular rings undergoing surgical division at 3 paediatric cardiac institutions between November 2007 and October 2019 was performed.
RESULTS
The complete vascular rings consisted of a double aortic arch (24.5%), right aortic arch with left ligamentum arteriosum (36.7%) and left aortic arch, with right ligamentum arteriosum (0.5%). The incomplete vascular rings consisted of a pulmonary artery sling (22.9%), left aortic arch with aberrant right subclavian artery (15.1%) and innominate artery compression syndrome (0.3%). Respiratory symptoms included stridor (71.4%), wheezing (49.1%), coughing (31.5%), gastrointestinal symptoms included choking (12.4%), dysphagia (3.2%) and emesis (1.9%). Only one patient died after discharge, yielding a late mortality rate of 0.3% (1/360). The 10-year overall survival rate was 96.8%. Postoperative complications were reported in 51 patients, 15 of whom required reoperation. The 10-year freedom from reoperation rate was 95.9%. Follow-up was completed in 95.4% (354/371) of patients, with a mean follow-up time of 4.3 ± 2.9 years (range from 1 to 13 years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up.
CONCLUSIONS
The outcomes of vascular ring division are excellent. A Kommerell diverticulum >1.5 times the aberrant left subclavian artery origin is an operative indication for primary resection. Tracheomalacia is a risk factor for reoperation and residual symptoms, and preoperative fibrobronchoscopy is important for evaluation.
Topics: Aorta, Thoracic; Aortic Diseases; Child; Heart Defects, Congenital; Humans; Subclavian Artery; Vascular Ring
PubMed: 34632492
DOI: 10.1093/ejcts/ezab432 -
SAGE Open Medical Case Reports 2023A female infant, born at 37 week 5 days to a mother via induced vaginal delivery for preeclampsia, was prenatally diagnosed with a right aortic arch with vascular ring....
A female infant, born at 37 week 5 days to a mother via induced vaginal delivery for preeclampsia, was prenatally diagnosed with a right aortic arch with vascular ring. On the third day of life, the infant exhibited a bronze-gray coloration, and a direct bilirubin of 1.7 mg/dL was detected. The abdominal ultrasound did not visualize the gallbladder. Clinically, the infant displayed features consistent with Alagille syndrome, including unusual facial appearance, butterfly vertebrae, cardiovascular defects, and cholestasis. The geneticist noted that the mother of the patient also exhibited similar features. Both the infant and the mother were diagnosed with Alagille syndrome, both having the same heterozygous JAG1 gene (NM_000214.2) variant (c.1890_1893del, p.Ile630Metfs*112). We believe that the vascular ring observed in our patient is the first reported instance of a vascular ring associated with Alagille syndrome.
PubMed: 37667743
DOI: 10.1177/2050313X231197321 -
Cureus Dec 2023Even though cardiac computed tomography and magnetic resonance imaging are the gold standard for evaluating the aortic arch in the context of vascular rings in children,... (Review)
Review
Even though cardiac computed tomography and magnetic resonance imaging are the gold standard for evaluating the aortic arch in the context of vascular rings in children, echocardiography is usually the first-line modality. The echocardiographic evaluation of the aortic arch in the context of vascular rings in children has received little attention. This article details the step-by-step echocardiographic assessment of the aortic arch in vascular ring patients.
PubMed: 38249193
DOI: 10.7759/cureus.50899