Outcomes of Surgical Repair of Vascular Rings and Slings in Children: A Word for the Asymptomatic

Said, Sameh M.; Marey, Gamal; Knutson, Stacie; Rodgers, Nathan; Richtsfeld, Martina; Joy, Brian F.; Griselli, Massimo

doi:10.1053/j.semtcvs.2020.09.013

Cited by 17 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, a dramatic evolution in recent surgical techniques has contributed to the excellent outcomes. Concomitant procedures to simultaneously correct vascular compression and all the airway defects by using slide tracheoplasty can prevent multiple reoperations with their attendant increased risks ( 9 , 13 ), which would probably pose benefits to our case.…”

Section: Discussionmentioning

confidence: 89%

“…In this setting, some cases are redirected to surgery in critical clinical status, with postoperative mortality being reported to be 50% as compared to 6.4% in its absence ( 9 ). Additionally, even without critical clinical conditions, symptomatic cases still have higher perioperative morbidities and mortalities in comparison to asymptomatic ones ( 13 ). Persistent airway compression might contribute to long-term tracheobronchomalacia and defective ventilation, resulting in persistence of airway symptoms and lung parenchymal hypoplasia despite relief of the compression ( 13 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, even without critical clinical conditions, symptomatic cases still have higher perioperative morbidities and mortalities in comparison to asymptomatic ones ( 13 ). Persistent airway compression might contribute to long-term tracheobronchomalacia and defective ventilation, resulting in persistence of airway symptoms and lung parenchymal hypoplasia despite relief of the compression ( 13 , 14 ). Furthermore, it has been suggested that unrepaired VRs might be associated with neurocognitive problems ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report

Shi

Wang

Hua

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Pulmonary artery sling (PAS) is a rare but fatal malformation. Patients with PAS tend to develop obstructive symptoms in few weeks of life. Conversely, some patients may be otherwise mild or asymptomatic in their early life. Currently, no consensus on the intervention timing and treatment strategy for asymptomatic and mild cases has been reached. Moreover, the extent of tracheal stenosis is another determining factor for the choice of intervention timing since clinical symptoms might not correspond well with the degree of stenosis. Lack of comprehensive assessment of entire airways confer underestimation of disease severity and in turn improper choice of treatment regimens and poor outcomes. Herein, we described an infantile case of PAS, who was scheduled initially for periodic outpatient follow-up on account of the absence of symptoms and inadequate imaging assessment at diagnosis. The patient developed recurrent wheezing and progressive respiratory distress at 7 months of age. After left pulmonary artery (LPA) reimplantation without tracheal intervention, bronchoscopy was performed due to failure to wean from mechanical ventilation, which demonstrated complete tracheal cartilage rings, a long segment tracheal stenosis, a low tracheal bifurcation at T6, and the absence of a separate right middle lobe bronchus. The patient was finally diagnosed with type IIb PAS and extubated successfully following conservative treatment. Miserably, neurological sequelae were devastating, leading to poor outcomes. Comprehensive airway evaluation using bronchoscopy is substantial to early identification of all components responsible for airway compromise in PAS anatomic subtypes. Considering severe concomitant maldevelopment of the bronchial tree in children with type IIb PAS, early and complete correction by surgery might decrease perioperative morbidities and mortalities of these patients.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report

Shi

Wang

Hua

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…It has been shown that children with a DAA tend to present earlier with symptoms/signs of trache‐oesophageal compression and are more likely to be associated with residual respiratory post‐operative morbidity compared to RAA 2,4‐13 . with some surgical centres advocating universal early surgery 13‐16 . Accurate prenatal diagnosis of vascular rings assists with perinatal management by facilitating parental education such that possible clinical features can be identified early, leading to timely assessment and treatment 4 .…”

Section: Introductionmentioning

confidence: 99%

“…2,[4][5][6][7][8][9][10][11][12][13] with some surgical centres advocating universal early surgery. [13][14][15][16] Accurate prenatal diagnosis of vascular rings assists with perinatal management by facilitating parental education such that possible clinical features can be identified early, leading to timely assessment and treatment. 4 Prenatal diagnosis has also been shown to be associated with less residual respiratory morbidity after surgical repair particularly in children with a DAA 17,18 and there is interest in early repair to prevent long term morbidity.…”

Section: Introductionmentioning

confidence: 99%

Fetal echocardiographic markers to differentiate between a right and double aortic arch

et al. 2022

View full text Add to dashboard Cite

Objectives To describe the fetal echocardiographic features of a double aortic arch (DAA) and secondly, to assess the performance of these features to differentiate between a right aortic arch with left duct (RAA‐LD) in a blinded cohort of vascular rings. Methods Review of records to identify surgically confirmed cases of DAA diagnosed prenatally from 2014 to 2018 (cohort‐A). Prenatal echocardiograms were reviewed and the segments of the aortic arches anterior and posterior to the trachea, aortic isthmuses and the presence/absence of the Z‐sign were described. The utility of these markers were assessed in a separate cohort (B) of fetuses with surgically confirmed cases of DAA or RAA‐LD. Results Cohort‐A comprised 34 cases with DAA; there was a dominant RAA in 32/34 (94%) and balanced left aortic arch (LAA) and RAA in two cases. The proximal LAA was seen in 29/34 (85%), distal LAA in 15/34 (44%) and the LAA aortic isthmus in 4/34 (12%). The “Z” configuration was present in 29/34 (85%) cases. The most predictive marker for DAA in cohort‐B was the Z‐sign (sensitivity: 100%, specificity: 81%). Conclusion The “Z” sign is a useful differentiator between RAA‐LD and DAA. The absence of visualization of the left aortic isthmus does not preclude the presence of a DAA.

show abstract

Vascular Rings and Slings

Agarwal

2021

Pediatric Cardiac CT in Congenital Heart Disease

View full text Add to dashboard Cite

Outcomes of Surgical Repair of Vascular Rings and Slings in Children: A Word for the Asymptomatic

Cited by 17 publications

References 19 publications

A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report

A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report

Fetal echocardiographic markers to differentiate between a right and double aortic arch

Vascular Rings and Slings

Contact Info

Product

Resources

About