Congenital Aortic Vascular Ring: In-Utero Sonographic Assessment of Tracheal Patency and Postnatal Outcome

2020 ◽  
Author(s):  
Reuven Ryszard Achiron ◽  
Eran Kassif ◽  
Yinon Gilboa ◽  
Yishay Salem ◽  
Yizhak Jakobson ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Vascular Ring ◽  
In Utero ◽  
Outcome Data ◽  
Tracheal Compression ◽  
Airway Occlusion ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Postnatal Outcome

Abstract 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.

Postnatal impact of a prenatally diagnosed double aortic arch

2020 ◽  
pp. archdischild-2020-318946
Author(s):  
Trisha V Vigneswaran ◽  
Milou PM Van Poppel ◽  
Benedict Griffiths ◽  
Paul James ◽  
Haran Jogeesvaran ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Double Aortic Arch ◽  
Comparative Genomic Hybridisation ◽  
Comparative Genomic ◽  
Published Data ◽  
Fetal Cardiology ◽  
Tracheal Compression ◽  
Postnatal Outcome ◽  
Clinical Records

BackgroundA double aortic arch (DAA) is increasingly identified before birth; however, there are no published data describing the postnatal outcome of a large prenatal cohort.ObjectiveTo describe the associations, symptoms and impact of prenatally diagnosed DAA.MethodsRetrospective review of consecutive cases seen at two fetal cardiology units from 2014 to 2019. Clinical records including symptoms and assessment of tracheobronchial compression using flexible bronchoscopy were reviewed. Moderate–severe tracheal compression was defined as >75% occlusion of the lumen.ResultsThere were 50 cases identified prenatally and 48 with postnatal follow-up. Array comparative genomic hybridisation (aCGH) was abnormal in 2/50 (4%), aCGH was normal in 33/50 (66%) and of those reviewed after birth, 13 were phenotypically normal. After birth, there was a complete DAA with patency of both arches in 8/48 (17%) and in 40/48 (83%) there was a segment of the left arch which was a non-patent, ligamentous connection.Stridor was present in 6/48 (13%) on the day of birth. Tracheo-oesophageal compressive symptoms/signs were present in 31/48 (65%) patients at median age of 59 days (IQR 9–182 days). Tracheal/carinal compression was present in 40/45 (88%) cases. Seven of 17 (41%) asymptomatic cases demonstrated moderate–severe tracheal compression. All morphologies of DAA caused symptoms and morphology type was not predictive of significant tracheal compression (p=0.3).ConclusionsGenetic testing should be offered following detection of double aortic arch. Early signs of tracheal compression are common and therefore delivery where onsite neonatal support is available is recommended. Significant tracheal compression may be present even in the absence of symptoms.

Vascular ring surgery – can we do better?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Amir ◽  
N Soffair ◽  
G Frenkel ◽  
E Bruckheimer ◽  
E Nachum ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Respiratory Symptoms ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Mirror Image ◽  
Vascular Rings ◽  
Number Of Patients ◽  
Age At Surgery

Abstract Background Vascular anomalies of the Aortic arch can cause respiratory symptoms in children due to tracheal compression. Treatment consists of division of the vascular rings, nevertheless data regarding mid- term results is scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. Methods Between2007–2014, 85 children underwent vascular ring surgery. 51 had Double Aortic Arch (DAA, 60%), 31 Right Arch with Aberrant Subclavian Artery (RAA & ALSA, 36.5%) and 3 had RAA, mirror image branching & left ductus arteriosus (3.5%). Mean age and weight at operation were 12.4±13months and 8.6±4.1 kg respectively. Mid-term follow-up included clinical follow up by a pulmonologist (38 patients, 44.7%) and a telephone questionnaire (71 patients, 83%) performed 57±25.7 months after surgery. Results In most patients, symptomatic relief occurred in less than 6 months (table 1). Mid –term follow up revealed that although most parents described a significant improvement in their child's respiratory symptoms (95%), a significant number of patients described some residual respiratory symptoms (table 2). We did not find any significant association between age at surgery (under 6 month), or vascular ring anatomy (DAA vs. RAA&ASA) and the presence of residual symptoms at follow up Conclusions Surgical division of vascular rings results in a significant clinical improvement within one year, nevertheless many patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms in mid- term follow up. Further evaluation whether a more aggressive surgical approach is warranted in order to decrease the incidence long-term symptoms. Funding Acknowledgement Type of funding source: None

Absence of cardiovascular effects on young adults exposed in utero to ritodrine: A long-term follow-up

2009 ◽  
Vol 142 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Miguel Álvarez-Seoane ◽  
Salvador Pita-Fernández ◽  
Mª Begoña Cid ◽  
Constancio Medrano-Lopez ◽  
Fernando Rueda-Nuñez
Keyword(s):  
Young Adults ◽  
Cardiovascular Effects ◽  
In Utero ◽  
Long Term Follow Up

Double aortic arch: an elusive diagnosis in a child with CHD

2021 ◽  
pp. 1-3
Author(s):  
Mariana Lemos ◽  
Miguel Fogaça da Mata ◽  
Ana Coutinho Santos
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Ct Angiography ◽  
Septal Defect ◽  
Vascular Ring ◽  
Pulmonary Atresia ◽  
Double Aortic Arch ◽  
Shunt Surgery

Abstract An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

scholarly journals Aorto-esophageal fistula: successful open surgical management of two cases

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Siddharth Pahwa ◽  
Susmit Bhattacharya ◽  
Siddhartha Mukhopadhyay ◽  
Ashok Verma
Keyword(s):  
Surgical Management ◽  
Surgical Repair ◽  
Hemodynamic Instability ◽  
Esophageal Fistula ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Dacron Patch ◽  
Upper Gastrointestinal

Abstract An aorto-esophageal fistula (AEF) is a rare yet life-threatening cause of upper gastrointestinal bleeding. We report our experience with open surgical management of two cases of AEF. Both cases presented with almost identical presentations: hematemesis and hemodynamic instability. The aorta in the first patient was normal; the defect was small and was repaired with a Dacron patch. The second patient had an aneurysmal aorta, which was replaced with a Dacron graft. Both cases were performed under partial bypass. The esophageal rent in both patients was debrided, primarily closed and buttressed with a vascularized intercostal pedicle. Nonavailability of endovascular personnel and equipment along with hemodynamic instability of the patient influenced our surgical strategy. Long-term follow-up of these patients is necessary to analyze the outcomes of our surgical repair.

scholarly journals Typical Asthmatic Presentation of Congenital Vascular Ring Can Masquerade a General Physician

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Naveen Swami ◽  
Georgey Koshy ◽  
Maan Jamal ◽  
Thair S. Abdulla ◽  
Abdulaziz Alkhulaifi
Keyword(s):  
Aortic Arch ◽  
Vascular Ring ◽  
Chest Ct ◽  
General Physician ◽  
Ligamentum Arteriosum ◽  
Tracheal Compression ◽  
X Ray ◽  
Chest X Ray

A 24-year-old woman was referred to pulmonologist with worsening breathlessness and wheeze. During childhood, she was diagnosed with asthma and subsequent exacerbations were treated with bronchodilators for many years. The chest X-ray and a spirometry testing raised a doubt of extrinsic tracheal compression and a subsequent enhanced chest CT (computerized tomogram) scan confirmed a right-sided aortic arch and a vascular ring anomaly compressing the trachea. Standard surgical division of ligamentum arteriosum was able to relieve the trachea and so the symptoms.

Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor

2006 ◽  
Vol 104 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Chow Huat Chan ◽  
Richard G. Bittar ◽  
Gavin A. Davis ◽  
Renate M. Kalnins ◽  
Gavin C. A. Fabinyi
Keyword(s):  
Outcome Data ◽  
Temporal Lobectomy ◽  
Class I ◽  
Surgical Removal ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Seizure Outcome ◽  
Short Term ◽  
Long Term Follow Up

Object Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy. Methods The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially. Conclusions Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.

Surgical Management of Right Aortic Arch Obstruction Associated With Rare Form of Vascular Ring

2020 ◽  
Vol 11 (2) ◽  
pp. 222-225
Author(s):  
Evgeny V. Krivoshchekov ◽  
Frank Cetta ◽  
Oleg A. Egunov ◽  
Evgenii A. Sviazov ◽  
Valeriy O. Kiselev ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Surgical Management ◽  
Rare Case ◽  
Vascular Ring ◽  
Right Aortic Arch ◽  
Rare Form ◽  
Descending Aorta ◽  
Arch Obstruction ◽  
Right Descending Aorta

This clinical case demonstrated surgical management for a rare case of vascular ring associated with an elongated and kinked aortic arch and a right descending aorta in a ten-year-old male using an extra-anatomic bypass grafting method and dividing the vascular ring. Computer tomography performed at six-month follow-up showed a favorable surgical outcome.

scholarly journals Coronaric Stent-Graft Deployment in the Treatment of Carotid Blowout

2011 ◽  
Vol 17 (4) ◽  
pp. 490-494 ◽  
Author(s):  
E. Pampana ◽  
R. Gandini ◽  
M. Stefanini ◽  
S. Fabiano ◽  
A. Chiaravalloti ◽  
...  
Keyword(s):  
Stent Graft ◽  
Clinical Results ◽  
Covered Stent ◽  
Endovascular Stent Graft ◽  
Carotid Blowout Syndrome ◽  
Rescue Treatment ◽  
Long Term Follow Up ◽  
Life Threatening

“Carotid blowout syndrome” is defined as a hemorrhage caused by rupture of the carotid artery and its branches, and may be a severe complication of rhinopharyngeal carcinoma. This study aimed to highlight the usefulness and versatility of endovascular stent-graft placement as a rescue treatment in life-threatening carotid blowout syndrome. We describe the unconventional use of a 6×5 mm balloon-expandable coronaric covered stent in a patient with a diagnosis of spinocellular rhinopharyngeal carcinoma, followed by carotid blowout syndrome. Although long-term follow-up is needed to assess the eventuality of bleeding recurrence, the immediate clinical results were satisfactory.

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