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The Journal of Thoracic and... Jan 2012This study observed midterm results of vascular ring connectors in surgery for aortic dissection.
OBJECTIVES
This study observed midterm results of vascular ring connectors in surgery for aortic dissection.
METHODS
Vascular ring connectors were used as stents in vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure ringed vascular grafts from outside the aorta.
RESULTS
From November 2007 to February 2011, 113 consecutive patients with aortic dissection, except 3 in preoperative profound shock, underwent open surgery. All underwent aortic reconstruction with vascular grafts and vascular ring connectors: ascending aorta in 29, descending thoracic aorta in 20, distal hemiarch plus descending thoracic aorta in 22, total arch in 14, ascending aorta plus total arch in 12, total arch plus descending thoracic aorta in 7, ascending aorta plus arch plus descending thoracic aorta in 8, and thoracoabdominal aorta in 1. Concomitant operations were 19 Bentall procedures, 14 coronary bypasses, 2 mitral valve replacements, 1 aortic valve replacement, and 1 heart transplant. We used sternotomy to repair 77% of type B dissections, 83% with elephant trunks. Time to extubation was 9.0 ± 6.2 hours. Average blood loss was 345 ± 195 mL. Half the patients needed no blood transfusion. In-hospital mortality was 5.3%; late mortality was 2.7%.
CONCLUSIONS
Use of vascular ring connectors in surgical repair for aortic dissection might reduce risks and improve early and midterm results. With addition of elephant trunk, most type B dissections could be repaired through sternotomy. With the improved surgical results, we can suggest open repair for most uncomplicated type B dissections; however, more long-term follow-up is needed.
Topics: Adult; Aged; Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis Implantation; Female; Humans; Male; Middle Aged; Stents; Time Factors; Treatment Outcome
PubMed: 22014712
DOI: 10.1016/j.jtcvs.2011.09.013 -
Texas Heart Institute Journal Sep 2022Vascular ring is a rare congenital anomaly in which the abnormal origin of the aorta or its branches and pulmonary arteries leads to encircling and compression of the...
Vascular ring is a rare congenital anomaly in which the abnormal origin of the aorta or its branches and pulmonary arteries leads to encircling and compression of the trachea and esophagus. A right aortic arch (RAA) with an aberrant left subclavian artery is one of the most common forms of vascular ring. Here, we report a case of a prenatally diagnosed vascular ring resulting from an RAA with an aberrant left subclavian artery. When the infant was 7 months of age, the development of noisy breathing prompted further evaluation with cardiac magnetic resonance imaging that showed an atretic left subclavian artery associated with collateral retrograde flow from the left vertebral artery to the distal portion of the subclavian artery. Our findings indicate that an untreated RAA with an aberrant left subclavian artery may be associated with an increased risk of developing subclavian artery steal syndrome.
Topics: Aorta, Thoracic; Cardiovascular Abnormalities; Humans; Infant; Subclavian Artery; Subclavian Steal Syndrome; Vascular Ring
PubMed: 36191603
DOI: 10.14503/THIJ-20-7415 -
Respirology Case Reports Apr 2020Anomalies of the aortic arch associated with Kommerell diverticulum (KD) are rare congenital malformations. Symptomatic thoracic vascular rings presenting in adults are...
Anomalies of the aortic arch associated with Kommerell diverticulum (KD) are rare congenital malformations. Symptomatic thoracic vascular rings presenting in adults are rare. We report a case of a 39-year-old woman who was diagnosed with uncontrolled asthma. She was complaining of worsening respiratory symptoms with dysphagia. Imaging studies and preoperative findings concluded to type II congenital anomaly of the aortic arch or Neuhauser's anomaly: a right-sided aortic arch with aberrant left subclavian artery, tracheoesophageal compression by KD and ligamentum arteriosum (LA). This compression was relieved by the resection of the LA and KD.
PubMed: 32076553
DOI: 10.1002/rcr2.535 -
European Journal of Cardio-thoracic... May 2022Our goal was to describe postoperative complications and outcomes in a large contemporary cohort of children with an isolated double aortic arch (DAA) or a right aortic...
OBJECTIVES
Our goal was to describe postoperative complications and outcomes in a large contemporary cohort of children with an isolated double aortic arch (DAA) or a right aortic arch (RAA) with left arterial ligament and to assess the impact of foetal diagnosis on outcomes.
METHODS
We performed a retrospective analysis of all patients who underwent surgery for DAA or RAA with left arterial ligament between 2005 and 2019.
RESULTS
A total of 132 children were operated on for a DAA (n = 77) or a RAA (n = 55). Prenatal diagnosis was made in 100/132 (75.8%). Median age at surgery for DAA was 5.0 (1.7-13.3) months and for RAA was 13.9 (6.4-20.1) months. There was no difference in the age at surgery between the prenatal and postnatal cases (8.6 [4.0-15.6] vs 5.4 months [1.8-17.7]; P = 0.37). No surgical deaths occurred. Vocal cord palsy was the most common complication, occurring in 12/132 (9%): of these, 11 resolved spontaneously and 1 required a temporary tracheostomy. Logistic regression demonstrated that older age at operation was the only predictor for a postoperative complication (P = 0.02). Overall, 21/67 (31%) of prenatally detected, symptomatic cases reported residual symptoms/signs 1 year after surgery compared to 18/28 (64%) of postnatally detected cases. Postnatal diagnosis was associated with persistent postoperative symptoms/signs [P = 0.006, odds ratio = 3.9 (95% confidence interval 1.5-9.4)].
CONCLUSIONS
Surgery to relieve a vascular ring resolves trache-oesophageal compressive symptoms in most cases, but parents/patients should be aware that symptoms/signs may persist in the first postoperative year despite effective release of the vascular ring. Earlier surgery and prenatal diagnosis may improve outcomes.
Topics: Aorta, Thoracic; Aortic Arch Syndromes; Child; Female; Humans; Infant; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Treatment Outcome; Ultrasonography, Prenatal; Vascular Ring
PubMed: 35022705
DOI: 10.1093/ejcts/ezab527 -
Interactive Cardiovascular and Thoracic... Feb 2017Complete vascular rings are rare and cause tracheoesophageal compression. Following surgical division, some patients have persisting tracheomalacia. We aim to assess the...
OBJECTIVES
Complete vascular rings are rare and cause tracheoesophageal compression. Following surgical division, some patients have persisting tracheomalacia. We aim to assess the long-term outcomes of complete vascular ring division.
METHODS
All patients (n = 132) who underwent surgical division of a complete vascular ring between 1978 and 2014 were identified from the hospital database and retrospectively reviewed.
RESULTS
Complete vascular rings consisted of a double aortic arch (n = 80), right aortic arch with an aberrant subclavian artery and left ligamentum arteriosum (n = 50), right aortic arch with mirror image branching and left ligamentum arteriosum (n = 1), and a left aortic arch with right descending aorta and right ligamentum arteriosum (n = 1). Kommerell's diverticulum was identified in 10 patients. Preoperative tracheomalacia was identified via bronchoscopy in 25 patients. Concomitant tracheal reconstruction was not performed in any patient. Kommerell's diverticulum was resected in 1 patient. The hospital mortality rate was 1.5% (2/132). There were no late deaths. The overall survival rate was 98.3 ± 1.2% (95% CI: 93.4, 99.6) at 20 years. Postoperatively, persistent tracheal compression was reported in 3 patients, and tracheomalacia in 16 patients. The rate of freedom from reoperation was 88.6 ± 4.0% (95% CI: 77.9, 94.3) at 20 years. No patient required tracheal surgery during the follow-up period. Follow-up was 92% (121/132) complete, with a median follow-up of 11.4 years (range 44 days to 36 years). At the last follow-up, 7 patients had mild tracheomalacia.
CONCLUSIONS
Outcomes of division of a complete vascular ring are excellent. Tracheomalacia often improves following division of the vascular ring. Respiratory symptoms following complete vascular ring division are uncommon.
Topics: Adolescent; Aneurysm; Aorta, Thoracic; Aortic Arch Syndromes; Aortic Diseases; Bronchoscopy; Cardiovascular Abnormalities; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Subclavian Artery; Treatment Outcome; Vascular Malformations
PubMed: 27798062
DOI: 10.1093/icvts/ivw344 -
Echocardiography (Mount Kisco, N.Y.) Mar 2021Vascular rings (VRs) are defined as congenital abnormalities of the aortic arch and its branches. VR can form a ring that may compress the esophagus and trachea, which...
Vascular rings (VRs) are defined as congenital abnormalities of the aortic arch and its branches. VR can form a ring that may compress the esophagus and trachea, which likely result in feeding difficulties and respiratory distress. Physicians performing fetal echocardiography are knowledgeable about VRS and can provide this information to pediatric cardiothoracic surgeons. However, VRs are rare and can be missed. The three vessels and trachea (3VT) view used to diagnose VRs has been reported in the literature multiple times but in a small series. We diagnosed three cases of VRs using high-definition (HD) flow render mode and spatiotemporal image correlation (STIC). The composition of the VRs and vessel connections were shown more intuitively. This article reports our experience of the following related cases. In addition, postnatal imaging features of VRs were also evaluated.
Topics: Aorta, Thoracic; Child; Echocardiography; Female; Fetal Heart; Heart Defects, Congenital; Humans; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal; Vascular Ring
PubMed: 33586787
DOI: 10.1111/echo.14919 -
Human Genome Variation 2019HDR syndrome (OMIM #146255) is caused by haploinsufficiency of the gene. A vascular ring has not been reported in patients with -associated HDR syndrome. We report a...
HDR syndrome (OMIM #146255) is caused by haploinsufficiency of the gene. A vascular ring has not been reported in patients with -associated HDR syndrome. We report a neonatal case of HDR syndrome and a vascular ring that were possibly due to a novel frameshift mutation in the gene.
PubMed: 31885872
DOI: 10.1038/s41439-019-0087-1 -
Ultrasound in Obstetrics & Gynecology :... Jan 2020
Topics: Adult; Cardiovascular Abnormalities; Diagnosis, Differential; Ductus Arteriosus, Patent; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Trimester, Second; Subclavian Artery; Tomography, X-Ray Computed; Ultrasonography, Prenatal; Vascular Ring
PubMed: 31162848
DOI: 10.1002/uog.20365 -
The Annals of Thoracic Surgery May 1992The records of 21 patients who underwent operation for symptoms attributable to vascular ring were reviewed. The study covered 33 years, 1958 to 1991, and the mean...
The records of 21 patients who underwent operation for symptoms attributable to vascular ring were reviewed. The study covered 33 years, 1958 to 1991, and the mean follow-up was 6.8 years. The patients ranged from 7 days to 26 years old with a mean age of 2.9 years. Twenty patients were symptomatic. Symptoms were due to tracheal compression in 16 patients, esophageal compression in 2, and both causes in 2. During the first 30 years, chest roentgenography, barium swallow, and aortography constituted the diagnostic workup in the majority of the patients. During the last 3 years, magnetic resonance imaging replaced aortography. The surgical diagnosis included five variants of vascular ring. The surgical approach consisted of left thoracotomy in 19 patients and right thoracotomy in 2. These 2 had the diagnosis of right aortic arch with posterior left subclavian artery. In both instances, preoperative angiographic data determined the surgical approach. Barium swallow may be sufficient for the diagnosis of vascular ring; however, additional data are useful in determining the surgical approach. Magnetic resonance imaging can yield accurate data without subjecting the patient to the risks associated with angiography.
Topics: Adolescent; Adult; Angiography; Aorta, Thoracic; Barium Sulfate; Child; Child, Preschool; Esophageal Stenosis; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Postoperative Complications; Pulmonary Artery; Retrospective Studies; Subclavian Artery
PubMed: 1570988
DOI: 10.1016/0003-4975(92)91459-m -
World Journal For Pediatric &... Mar 2020We describe a neonate with an unusual vascular ring formed by a right-sided aortic arch with associated coarctation and distal hypoplasia in the presence of an aberrant...
We describe a neonate with an unusual vascular ring formed by a right-sided aortic arch with associated coarctation and distal hypoplasia in the presence of an aberrant left subclavian artery. The descending aorta traveled behind the esophagus to descend on the left side of the spine. A left ductus arteriosus connected to the descending aorta completing the vascular ring, with notable esophageal compression. Surgical correction was accomplished through median sternotomy, resection of the hypoplastic circumflex arch, aortic arch advancement, and end-to-side anastomosis.
Topics: Anastomosis, Surgical; Aorta, Thoracic; Aortic Coarctation; Cardiovascular Abnormalities; Ductus Arteriosus; Ductus Arteriosus, Patent; Echocardiography; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Sternotomy; Subclavian Artery; Vascular Ring
PubMed: 31104570
DOI: 10.1177/2150135119828387