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The Journal of Thoracic and... Sep 2009To improve the surgical results of aortic dissection, we used a novel vascular ring connector for anastomosis.
OBJECTIVE
To improve the surgical results of aortic dissection, we used a novel vascular ring connector for anastomosis.
METHODS
The vascular ring connector is a titanic ring used as a stent in the vascular graft to achieve a quick, blood-sealed, and sutureless anastomosis. From November 2007 to December 2008, 19 consecutive patients (age range 36-77 years; 16 male and 3 female) with aortic dissection underwent open surgery. All patients received aortic reconstruction with vascular grafts (including 5 cases of arch replacement). The combined procedures were 5 Bentall and 4 coronary artery bypass graft operations.
RESULTS
There were no significant blood leaks from the anastomotic sites. The time required for each anastomosis was 1 to 2 minutes. All patients were discharged uneventfully and are still doing well after a follow-up period of 1 to 12 months.
CONCLUSION
The vascular ring connector may improve the early surgical results of aortic dissection by reducing both the time for anastomosis and the risk of bleeding and may be an alternative technique for aortic reconstruction. Its usefulness in the routine treatment of aortic dissection warrants further evaluation.
Topics: Adult; Aged; Anastomosis, Surgical; Aortic Dissection; Aortic Aneurysm, Thoracic; Aortic Valve Insufficiency; Biocompatible Materials; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cardiopulmonary Bypass; Coronary Disease; Equipment Design; Female; Humans; Male; Middle Aged; Stents; Suture Techniques; Titanium
PubMed: 19698855
DOI: 10.1016/j.jtcvs.2009.02.008 -
Acta Cardiologica Jun 2023
Topics: Humans; Adolescent; Vascular Ring; Aorta, Thoracic; Delayed Diagnosis; Cardiovascular Abnormalities; Subclavian Artery; Heart Defects, Congenital; Diverticulum
PubMed: 36043992
DOI: 10.1080/00015385.2022.2096706 -
Seminars in Thoracic and Cardiovascular... 2021
Topics: Humans; Vascular Ring
PubMed: 33181300
DOI: 10.1053/j.semtcvs.2020.10.013 -
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 -
Journal of Thoracic Disease May 2024Vascular rings represent 1% of congenital cardiovascular abnormalities. Phenotypic expression varies from asymptomatic to severe forms related to either oesophageal or...
BACKGROUND
Vascular rings represent 1% of congenital cardiovascular abnormalities. Phenotypic expression varies from asymptomatic to severe forms related to either oesophageal or tracheal compression. While refinement in prenatal screening led to an increase in fetal diagnosis, optimal management in asymptomatic neonates and infants is currently a matter of debate. We report our center experience of vascular ring management over three decades.
METHODS
In this single-center retrospective study, data were extracted from patient medical records. To obtain information on symptoms/medication at follow-up, clinical records from pediatric clinics were reviewed. For patients followed in other institutions, a web-based questionnaire was sent to referring pediatricians.
RESULTS
Out of 82 patients, 69 were symptomatic (84%). Common symptoms included recurrent respiratory tract infections (43%), stridor (32%), gastro-esophageal reflux (33%), and dysphagia (26%). Diagnosis relied on cardiac ultrasound, barium swallow studies, and chest computerized tomography scan. Surgical repair (thoracotomy 91%) was performed in 79 patients (96%). Median age at repair was 13 [interquartile range (IQR), 4.4-48] months. There was no mortality. Minor complications occurred in 14 patients (18%). Median hospital length of stay was 7 (IQR, 6-9) days. In total, 24% of patients remained symptomatic (median follow-up 54 months). Half of those were asthma-related, with nearly 90% freedom from ring-related symptoms.
CONCLUSIONS
Most patients were symptomatic at the time of diagnosis. Vascular rings such as pulmonary slings or tracheal compression syndromes require prompt management. Despite surgery, 24% of patients were not symptom-free at follow-up. Finally, surgery in asymptomatic patients resulted in low morbidity supporting the current recommendation of early surgical repair.
LEVEL OF EVIDENCE
III.
PubMed: 38883675
DOI: 10.21037/jtd-23-1526 -
Journal of Pediatric Surgery Oct 2012Esophageal atresia with tracheoesophageal fistula (EA-TEF) associated with a right aortic arch poses a dilemma to the pediatric surgeon, often necessitating an operative... (Review)
Review
Esophageal atresia with tracheoesophageal fistula (EA-TEF) associated with a right aortic arch poses a dilemma to the pediatric surgeon, often necessitating an operative approach via a left thoracotomy. A right aortic arch may be associated with a vascular ring, and EA-TEF, too, has been reported in association with a vascular ring. Rarely, esophageal atresia is associated with a second esophageal anomaly, such as a so-called "esophageal lung." To our knowledge, there is no report of all three in one patient. We report the first case of a patient with associated EA-TEF, vascular ring (diverticulum of Kommerell), and esophageal lung. The literature is reviewed for these rare entities.
Topics: Diverticulum, Esophageal; Esophageal Atresia; Esophagus; Humans; Infant, Newborn; Subclavian Artery; Tracheoesophageal Fistula; Vascular Malformations
PubMed: 23084209
DOI: 10.1016/j.jpedsurg.2012.07.051 -
Annals of the Royal College of Surgeons... Jan 2017A 48-year-old woman was seen in a surgical outpatient clinic with a 2 year history of progressive dysphagia with occasional regurgitation, partially controlled with a...
A 48-year-old woman was seen in a surgical outpatient clinic with a 2 year history of progressive dysphagia with occasional regurgitation, partially controlled with a proton pump inhibitor. Primary investigations of pH testing and gastroscopy were normal, although a barium swallow study revealed significant hold-up at the aortic arch impression and a posterior right-sided oesophageal impression suggestive of a right-sided aortic arch. A follow-up computed tomography angiogram discovered a vascular ring encircling the trachea and oesophagus, formed by a right-sided aortic arch with aberrant aortic branches, and a Kommerell's diverticulum. It was deemed that the patient's symptoms were related to this vascular ring. The patient underwent stage-one surgery - an extra-anatomic bypass of the double aortic arch and right subclavian artery - and 4 months later a stent graft insertion over the origin of the diverticulum with the aim of complete symptomatic relief. This case presents a common symptom familiar to any clinician (dysphagia), which has been caused by a rare pathology. It is even more unusual that this should present itself in adulthood.
Topics: Aneurysm; Aorta, Thoracic; Cardiovascular Abnormalities; Computed Tomography Angiography; Deglutition Disorders; Diverticulum; Female; Humans; Middle Aged; Subclavian Artery; Vascular Malformations
PubMed: 27551905
DOI: 10.1308/rcsann.2016.0232 -
Annals of Medicine and Surgery (2012) Sep 2021Congenital vascular rings are rare in adults. The management is challenging when vascular rings present with concomitant aortic aneurysm and Kommerall's diverticulum.
INTRODUCTION AND IMPORTANCE
Congenital vascular rings are rare in adults. The management is challenging when vascular rings present with concomitant aortic aneurysm and Kommerall's diverticulum.
CASE PRESENTATION
We present a 68year old patient with a congenital vascular ring in the form of right sided aortic arch, with a retroesophageal left subclavian artery arising from an aneurysmal Kommerell's diverticulum. In addition, the patient had aneurysmal distal aortic arch and proximal descending aorta, causing severe symptomatic tracheal compression. The patient was successfully managed by debranching and reimplantation of head neck vessels to the ascending aorta through a median sternotomy, and concurrent endovascular stenting of the aneurysmal aorta.
CLINICAL DISCUSSION
A combination of complete vascular rings and aortic arch aneurysm poses a potentially higher surgical risk. The use of the less invasive endovascular stenting of the aorta as well as a limited open surgical approach offers a lesser risk, especially in poor pre-operative states.
CONCLUSION
A multidisciplinary team effort is key. Hybrid management of aneurysmal congenital vascular rings in high risk adults offers an attractive management alternative to conventional surgery.
PubMed: 34527233
DOI: 10.1016/j.amsu.2021.102778 -
The Annals of Thoracic Surgery Feb 2020This single-institution study assessed the midterm outcomes of patients undergoing complete vascular ring (CVR) repair and the need for reintervention.
BACKGROUND
This single-institution study assessed the midterm outcomes of patients undergoing complete vascular ring (CVR) repair and the need for reintervention.
METHODS
The study included all patients who underwent surgical repair of an isolated CVR from 1996 to 2018 at our institution. Patients who underwent concomitant intracardiac repair were excluded. Data analysis included demographics, type of anomaly, other congenital heart disease, clinical symptomatology, operative technique, perioperative outcomes, reoperation rates, and mortality.
RESULTS
CVR repair through open thoracotomy was performed in 148 patients (80 boys [54%]), median age, 1.04 years (interquartile range, 0.4-5.2 years), and median weight, 12.8 kg (interquartile range, 7.5-26.5 kg). The cohort included 72 patients with double aortic arch (DAA), 69 with right aortic arch (RAA) with aberrant left subclavian artery and left ligamentum arteriosum (LLA), 5 with RAA with left descending aorta and LLA, and 2 with RAA with mirror-image branching and LLA. There was 1 outpatient perioperative death (0.7%) 15 days postoperatively. Perioperative complications occurred in 20 patients (14%): 18 (12%) with chylothorax (3 required reintervention), 1 pneumothorax, and 1 vocal cord paresis. Two of 36 patients (5.5%) without primary diverticulum resection required reoperation and subclavian reimplantation at 3 and 4 years, and 1 patient required aortic translocation 9 years later for persistent symptoms.
CONCLUSIONS
Freedom from reoperation after CVR repair was 93% at 5 years and 86% at 10 years. A small proportion of patients who do not undergo diverticulum resection and aberrant left subclavian artery reimplantation at the time of CVR repair will require reintervention in the future.
Topics: Child, Preschool; Female; Humans; Infant; Male; Reoperation; Thoracotomy; Time Factors; Treatment Outcome; Vascular Ring
PubMed: 31421105
DOI: 10.1016/j.athoracsur.2019.06.076 -
Vascular and Endovascular Surgery 2009Vascular rings are a rare cause of symptoms in adult patients. We report the case of a 48-year-old woman presenting with dysphagia lusoria due to an uncommon vascular... (Review)
Review
Vascular rings are a rare cause of symptoms in adult patients. We report the case of a 48-year-old woman presenting with dysphagia lusoria due to an uncommon vascular ring: right aortic arch with mirror-image branching and a left ligamentum arteriosum. No previous reports exist of adult-onset dysphagia lusoria attributable to this anatomy. The patient underwent a limited muscle-sparing thoracotomy with division of the ligamentum. The division interrupted the vascular ring and relieved her esophageal compression. The presentation, evaluation, pathophysiology, and treatment of this condition are discussed.
Topics: Aorta, Thoracic; Aortic Diseases; Deglutition Disorders; Esophageal Stenosis; Esophagoscopy; Female; Gastroscopy; Humans; Magnetic Resonance Angiography; Middle Aged; Thoracotomy; Treatment Outcome; Vascular Surgical Procedures
PubMed: 18829585
DOI: 10.1177/1538574408323503