Surgical Management of Vascular Ring

Abstract

Between 1968 and 1980, 51 children had an operation for various forms of vascular ring. Additional cardiac malformations were present in five patients, and six had noncardiac congenital anomalies. Although symptoms started within the first month of life in 39 infants, only 16 came to operation under three months of age, and a delay of more than six months occurred in 15. Stridor, often life-threatening, and recurrent infections were the most common symptoms, but dysphagia was also important. The reasons for delay in diagnosis are discussed. Barium swallow provided the diagnosis in 44 patients and suggested it in a further four patients. Innominate artery compression of the trachea was not diagnosed by barium swallow. Operations of various types were performed. Accuracy in diagnosis is important because not all patients could be treated through the classic left thoracotomy. Severe tracheomalacia was responsible for the only two deaths in the series; one of these had tracheostomy performed in the referring hospital, the second child also had Fallot's tetralogy. The large majority of the patients have done well, 76% being asymptomatic at follow-up. Minimal to moderate stridor persists among the remainder to the present time.

Tracheoesophageal compression due to congenital vascular anomalies (vascular rings)

“…11,19 Tracheoesophageal fistula, hiatus hernia, gastroesophageal reflux, diaphragmatic eventration, imperforate or ectopic anus, horseshoe kidney, and vertebral anomalies (personal observation) have been anecdotally reported to be associated with vascular ring anomalies. 8,14,[17][18][19]45,46 …”

Anomalous subclavian artery: a group of 15 cases

“…gestivas e respiratórias concomitantes, de forma que o diagnóstico de anel vascular deve ser considerado em pacientes com sintomas respiratórios crônicos, especialmente se exacerbados pela alimentação ou associados à disfagia 3 . Fístula traqueoesofágica, hérnia de hiato, eventração diafragmática e refluxo gastroesofágico têm sido relatados em associação às malformações vasculares 5,6,16 e às malformações cardíacas 17 . Refluxo gastroesofágico esteve presente em 40% e malformações cardíacas, em 27% dos nossos casos.…”

“…O esofagograma é o principal exame no diagnóstico de vaso anômalo 4,5,16 e foi sugestivo em 14/15 dos casos. Os achados radiológicos de falha de enchimento posterior do esôfago no nível da segunda vértebra torácica à direita e da quarta à esquerda, com inclinação de 70 o de maneira persistente 3,12 18,[20][21][22][23] .…”

“…Os achados radiológicos de falha de enchimento posterior do esôfago no nível da segunda vértebra torácica à direita e da quarta à esquerda, com inclinação de 70 o de maneira persistente 3,12 18,[20][21][22][23] . O tratamento da artéria subclávia anômala direita sintomática sempre é cirúrgico 16 . Oito pacientes foram submetidos a esse procedimento e estão assintomáticos, enquanto os demais estão sendo avaliados periodicamente e aguardam tratamento cirúrgico.…”

Double Aortic Arch with Mirror-Image Dextrocardia

“…Double aortic arch usually requires surgical intervention (14,15,16), who have severe respiratory and/or gastrointestinal symptoms. Thoracotomy should be carried out on the side of the smaller or atretic aortic arch and on the side of the persistent ductus arteriosus or ligamentum arteriosum in symptomatic patients.…”