Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients

Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.

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Vascular rings

ESC CardioMed ◽

10.1093/med/9780198784906.003.0189 ◽

2018 ◽

pp. 805-807

Author(s):

Robert Yates

Keyword(s):

Aortic Arch ◽

Vascular Ring ◽

Significant Proportion ◽

Double Aortic Arch ◽

Schematic Model ◽

Cardiac Defects ◽

Ligamentum Arteriosum ◽

Vascular Rings ◽

Vascular Structures ◽

Upper Mediastinum

Vascular rings constitute 2% of all congenital cardiac malformations. Accurate prevalence is difficult to estimate because of the lack of symptoms in a significant proportion of cases. ‘Vascular ring’ refers to a variety of congenital vascular anomalies that encircle (partly or completely) and compress the oesophagus and trachea in the upper mediastinum. The vascular structures are not always patent (i.e. ligamentum arteriosum, atretic segment of aortic arch) but can still cause symptoms. The majority are isolated anomalies but some are associated with additional structural congenital cardiac defects. Most can be understood from the Edwards schematic model of a double aortic arch.

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Vascular ring surgery – can we do better?

European Heart Journal ◽

10.1093/ehjci/ehaa946.3210 ◽

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

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Complete Vascular Ring Detected by Barium Esophagography

Ear Nose & Throat Journal ◽

10.1177/014556130208100816 ◽

2002 ◽

Vol 81 (8) ◽

pp. 554-555 ◽

Cited By ~ 3

Author(s):

Liam J. Skinner ◽

Stephanie Ryan ◽

John D. Russell

Keyword(s):

Aortic Arch ◽

Vascular Ring ◽

Double Aortic Arch ◽

Vascular Rings ◽

Barium Esophagography

The diagnosis of a vascular ring can be made on the basis of characteristic findings on barium esophagography. We report a case of a double aortic arch in a 9-month-old girl that was diagnosed in this manner, and we briefly review the anatomic characteristics of vascular rings.

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Use of Contrast-Enhanced MR Angiography (CE-MRA) for the Diagnosis of a Vascular Ring Anomaly in a Dog

Case Reports in Veterinary Medicine ◽

10.1155/2012/316530 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Silke Hecht ◽

April M. Durant ◽

William H. Adams ◽

Gordon A. Conklin

Keyword(s):

Magnetic Resonance ◽

Aortic Arch ◽

Vascular Ring ◽

Ligamentum Arteriosum ◽

University Of Tennessee ◽

Contrast Enhanced ◽

Dry Food ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Band Crossing

A 4-month-old female mixed breed dog was presented to the University of Tennessee College of Veterinary Medicine with a history of regurgitation and cachexia. Thoracic radiographs revealed focal megaesophagus cranial to the heart base. Magnetic resonance imaging (MRI) was performed. True fast imaging with steady-state precession (TrueFISP), fast low angle shot (FLASH), and short tau inversion recovery (STIR) sequences were acquired prior to contrast medium administration. Contrast-enhanced magnetic resonance angiography (CE-MRA) demonstrated focal megaesophagus and position of the aortic arch to the right of the esophagus. A small ductus diverticulum and an indistinct linear soft tissue band crossing the esophagus were also noted. Surgical exploration confirmed MR diagnosis of a persistent right aortic arch (PRAA) with left ligamentum arteriosum. The dog improved following surgery but was unable to be transitioned to dry food. To our knowledge this is the first report describing the use of CE-MRA for preoperative diagnosis and guided surgical treatment of a vascular ring anomaly in a dog.

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P725 An unexpected direction: a case report of a double aortic arch in an asymptomatic woman in adulthood

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.397 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Campos ◽

C Vieira ◽

N Salome ◽

V H Pereira ◽

A Costeira Pereira ◽

...

Keyword(s):

Case Report ◽

Aortic Arch ◽

Ct Angiography ◽

Vascular Ring ◽

Double Aortic Arch ◽

Posterior Arch ◽

Vascular Rings ◽

Thoracic Ct ◽

Extrinsic Compression ◽

The Right

Abstract Introduction Complete vascular rings represent about 0.5-2% of all congenital cardiovascular malformations, with the double aortic arch (DAA) being the most common of the complete vascular rings, causing tracheoesophageal compression. The right (posterior) arch is usually dominant (70%), although the two arches can have the same size (5%). The left (anterior) arch is dominant in only approximately 25% of cases. In most cases, this anomaly is diagnosed during childhood due to symptoms caused by oesophageal or tracheal compression. For this reason, case reports of adults are rare. This report describes a case of a 61-year-old woman with DAA with dominant left arch, diagnosed accidentallyby thoracic CT angiography. Case Report Description A 61 years old woman with a previous story of hypertension and type 1 diabetes presented to the emergency service with dyspnoea and thoracic pain. She also referred a history of intermittent dysphagia and cough with at least 12 years of progression. All the parameters of the physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm with no evidence of acute ischemia and her blood analyses did not show any abnormalitie. She also performed a thoracic CT angiography, which excluded signs of pulmonary embolism, but revealed a vascular ring suggesting a double aortic arch with permeability in both right and left arches as well as their collaterals. The Cardiac MRI was performed with the purpose of excluding ischemia, confirming the double aortic arch with left dominance. The right arch, posterior to the oesophagus and trachea, and the left arch, in an anterior position, showed an anatomic compression of the oesophagus as well as the proximal trachea, capable of eliciting the symptoms mentioned. Other congenital anomalies were excluded. The echocardiography did not demonstrate any additional cardiac malformation. Endoscopy shows a pulsatile extrinsic compression of the esophagus (aortic ring). The patient is currently being studied and closely monitored in the Cardiology consultation. Discussion The most common type of complete vascular ring is the double aortic arch, which accounts for 70% of the complete rings. In most cases, there are two permeable arches, usually with right dominance (70% of the cases). Rarely, both arches are symmetrical. Symptoms usually appear in the fifth month of life. In most cases, only supportive treatment is required. Conclusion This case illustrates the atypical features of this congenital malformation, namely the diagnosis during adulthood as well as the left dominance. Abstract P725 Figure. A double aortic arch

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

Case Reports in Vascular Medicine ◽

10.1155/2013/934790 ◽

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.

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