scholarly journals Vascular ring, an uncommon presentation of BRUE in newborns

2018 ◽  
Vol 5 (6) ◽  
pp. 2341 ◽  
Author(s):  
Sneha Singh Dhruw ◽  
Abhishek Saini ◽  
Sourabh Singh
Keyword(s):  
Vascular Ring ◽  
Imaging Study ◽  
Branchial Arch ◽  
Respiratory Problems ◽  
Feeding Difficulties ◽  
Vascular Rings ◽  
Uncommon Presentation ◽  
Arch System ◽  
Embryologic Development ◽  
High Degree

 Vascular rings are a group of anomalies caused by abnormal embryologic development of the branchial arch system. They can lead to variable degrees of respiratory problems or feeding difficulties by forming a complete or partial ring compressing the trachea, the bronchi, and the oesophagus. Vascular rings not being so common, a missed diagnosis is much more common. Hence a high degree of suspicion along with appropriate imaging study is required to make a diagnosis. This case report describes an uncommon acute presentation of a vascular ring in newborn as a brief resolved unexplained event (BRUE).

Vascular rings and slings: interesting vascular anomalies

2011 ◽  
Vol 125 (11) ◽  
pp. 1158-1163 ◽  
Author(s):  
E Phelan ◽  
S Ryan ◽  
H Rowley
Keyword(s):  
Clinical Presentation ◽  
Vascular Ring ◽  
Case Series ◽  
Clinical Suspicion ◽  
Vascular Rings ◽  
Airway Symptoms ◽  
Different Types ◽  
Arch System ◽  
Derivatives Of ◽  
Prompt Diagnosis

AbstractIntroduction:A vascular ring refers to encirclement of the trachea and oesophagus by an abnormal combination of derivatives of the aortic arch system. These malformations can cause variable degrees of compression of the oesophagus, trachea or both. Symptoms can range from no effect to severe stridor, dyspnoea and/or dysphagia.Method and results:This study presents a case series of six patients treated over a six-year period (2003–2009), illustrating the features of four different types of vascular ring; these types are discussed in detail. The clinical presentation, radiology, and microlaryngoscopy and bronchoscopy findings are also discussed.Conclusion:The management of children with vascular rings requires a high index of clinical suspicion to ensure prompt diagnosis. As many of these children present with airway symptoms, the paediatric otolaryngologist plays a key role in identifying and assessing their anatomical anomalies.

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

Anatomical organization of aortic arch variation with embryological basis and clinical application

2021 ◽  
Vol 9 (1.3) ◽  
pp. 7901-7904
Author(s):  
Gayathri Pandurangam ◽  
◽  
D. Naga Jyothi ◽  
Asra Anjum ◽  
S. Saritha ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Clinical Application ◽  
Surgical Procedures ◽  
Wide Spectrum ◽  
Branchial Arch ◽  
Left Vertebral Artery ◽  
Branching Pattern ◽  
Brachiocephalic Trunk ◽  
Great Vessels ◽  
Arch System

Introduction: The variation in the aortic arch is well known and it has been demonstrated by number of researchers. Changes involved in the development of aortic arch system such as regression, retention or reappearance result in the variation in branching pattern of aortic arch. Variations of the branches of aortic arch are due to alteration of branchial arch arteries during embryonic period. The most common classical branching pattern of the aortic arch in humans comprises of three great vessels, which includes Brachiocephalic trunk, Left Common Carotid artery and Left Subclavian artery. Aim: The study is to determine the embryological basis correlating with clinical application and surgical procedures. Materials and Methods: A study was conducted in 50 formalin fixed cadaveric hearts, during a period of two years. In the routine dissection for 1st MBBS and also museum specimens we encountered 3variations in the branches of arch of aorta. Results: The variations in aortic arch branching pattern were observed in 4 cadaveric hearts (8%). Conclusion: The wide spectrum of variation in the human aortic arch and its branches offer valuable information to catheterize in endovascular surgery for diagnostic and surgical procedures in the thorax, head and neck regions. KEY WORDS: Aortic Arch (AA), Left Common Carotid (LCCA), Left Subclavian (LSA), Brachiocephalic Trunk (BCT), left vertebral artery(LVA).

scholarly journals Complete Vascular Ring Detected by Barium Esophagography

2002 ◽  
Vol 81 (8) ◽  
pp. 554-555 ◽  
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.

Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients

2005 ◽  
Vol 71 (4) ◽  
pp. 289-291 ◽  
Author(s):  
Curt S. Koontz ◽  
Amina Bhatia ◽  
Joe Forbess ◽  
Mark L. Wulkan
Keyword(s):  
Aortic Arch ◽  
Pediatric Patients ◽  
Vascular Ring ◽  
Operating Time ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Ligamentum Arteriosum ◽  
Vascular Rings ◽  
Computed Tomographic ◽  
Video Assisted

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.

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

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

DOZ047.62: Fixed the gap, solved the problem? Children operated on of esophageal atresia: what happen 3 years later

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
F Bevilacqua ◽  
B Ragni ◽  
A Conforti ◽  
F Morini ◽  
A Dotta ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Surgical Care ◽  
Health Care Team ◽  
Eating Problems ◽  
Respiratory Problems ◽  
Feeding Difficulties ◽  
Meal Time ◽  
Set Up

Abstract Background With improvements in surgical care long-term morbidity of patients with esophageal atresia (EA) has been recently taken into account (Lees et al., 2018). Morbidities include gastrointestinal and respiratory complication, problems of nutrition and growth, feeding difficulties, oral aversion or food refusal (Menzies et al., 2016). Aim Purpose of this study is to explore eating problems and its implications at 3 years in infants born with esophageal atresia. Methods A retrospective study including all infants operated for EA at our Institution in the period ranging from January 2012 and January 2016 who attended our follow-up program. A specific interview was set up for the study. The interview was delivered by telephone by a trained psychologist. Results Parents of 51 children (male = 67%) were interviewed. Twenty-two percent of children showed a growth <10th percentile; 30% presented oral aversion for a period of their life; 45% still have episodes of chock during meals and 18% of these had more than one episode a week; 45% suffer of GERD and 41% experienced recurrent respiratory problems; 37% of parents experience anxiety during meals. Fifty-seven percent attended kindergarten (8% with a dedicated educator during meal time), and 92% attended preschool (26% with dedicated educator during meal time). Currently 67% of the families benefit of social facilities. Conclusions Three years after surgical repair of the structural defect, a high percentage of family still experience physical and psychological problems related to eating behavior of their children. Efforts of the health care team as well as research should focus on how to prevent eating problems and improve quality of life both of children and families.

Computational Fluid Dynamics Simulation of Airflow Alteration in the Trachea Before and After Vascular Ring Surgery

2013 ◽  
Author(s):  
Tzu-Ching Shih ◽  
Tzyy-Leng Horng ◽  
Fong-Lin Chen
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Vascular Ring ◽  
Dynamics Simulation ◽  
Positive Pressure ◽  
Local Pressure ◽  
Pressure Drops ◽  
Vascular Rings ◽  
Before And After ◽  
Key Factor

Vascular rings, congenital intracardic anomalies of the aortic arch and the vessels emerging from the heart, completely encircle the trachea and esophagus [1]. The vascular ring results in narrowing and obstruction of the trachea and the esophagus. Due to the existence of a complete or partial vascular ring compressing either the trachea or esophagus, symptoms of a vascular ring in children include cough, stridor, chronic cough, dysphagia, persistent wheeze, and noisy breathing [2]. Some studies reported that the vascular ring surgery provides an excellent chance to improve the patient respiration conditions, especially for relief of symptoms [1–3]. Al-Bassam et al. reported that the thoracoscopic division of vascular rings in infants and children is a safe and effective surgery rather than an open thoracotomy[4]. Even after the treatment of a surgical division of the vascular ring, however, the fixed obstruction is relieved but the patient continues to have dynamic collapse because the compressed trachea segment is always malacic. Airway resistance to flow in the airway, thus, is a key factor for not only clinical diagnosis severity assessment but also therapeutic decision in tracheal stenosis. Furthermore, Malvè et al. (2011) utilized the finite element-based commercial software code (ADINA R&D Inc.) to model the fluid structure interaction of a human trachea under different ventilation conditions [5]. They also found that the positive pressure in the trachea does not result in the airway collapse during the time period of mechanical breathing. Therefore, the purpose of this study is to use the computational fluid dynamics (CFD) technique to calculate the local pressure drops in the tracheal segment for different inspiratory and expiratory flow rates due to preoperative and preoperative vascular ring surgery.

scholarly journals Double Aortic Arch – A Case Study

2017 ◽  
Vol 10 (1) ◽  
pp. 91-93
Author(s):  
Jahan Afroze ◽  
Musavvir Samin
Keyword(s):  
Aortic Arch ◽  
Clinical Skills ◽  
Vascular Ring ◽  
Final Diagnosis ◽  
Double Aortic Arch ◽  
Middle Aged ◽  
Ct Angiogram ◽  
Middle Aged Person ◽  
Aged Person ◽  
Arch System

Double aortic arch (DAA) is one of the 2 most common forms of vascular ring, a class of congenital anomalies of the aortic arch system in which the trachea and esophagus are completely encircled by connected segments of the aortic arch and its branches. The aim of this study is to describe a case of DAA in a middle aged person. A 40 year old male came to outdoor patient department with cough and breathlessness since childhood which was diagnosed earlier as bronchial asthma, cold allergy, and dust allergy. The final diagnosis DAA was made after CT angiogram. Establishing a diagnosis of DAA in a middle aged person requires thorough understanding and clinical skills in performing steps.Cardiovasc. j. 2017; 10(1): 91-93

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