Vascular rings

Rings and Slings: Not Such Simple Things

“…Therefore, it is crucial to actively investigate for intrinsic tracheal pathology in this population, employing a combination of bronchoscopy and cross-sectional imaging. Optical coherence tomography (OCT) has also been described for allowing the detection of complete cartilaginous rings in the trachea, as well as for assessing fragmentation or dysplastic features [ 42 ].…”

“…While it is clear when to intervene on patients presenting with symptoms in the context of a vascular ring, timing is more controversial in asymptomatic cases. In an attempt to assist clinical decision-making, Worhunsky and colleagues proposed an algorithm for the management of and, prenatally diagnosed vascular rings, including asymptomatic infants [ 42 ]. Although it may not become the standard of care for many institutions, it can be used as a guide, particularly when complemented with diagnostic testing, such as dynamic assessment of the airways, to help decide when surgery is necessary.…”

“…A left thoracotomy was then introduced as a better approach once the anatomy of this lesion was better understood. Nevertheless, the use of CPB has remarkably changed the course in the care of these patients, since it allows the repair of the almost always present, significant tracheal stenosis [ 42 ].…”

“…Extreme precaution should be taken not to injure the phrenic nerve; also, rotational distortion must be avoided, and the key to this is a constant check on the position of the left upper lobe division, which should be kept at its superior position until implantation. When tracheal reconstruction is needed, sliding tracheoplasty is the technique of choice due to its encouraging anatomical and clinical results [ 42 ].…”

“…Children with PA sling who do not require tracheal surgery have excellent clinical outcomes. Mortality in these patients is driven by the need for additional tracheal surgery, which has a combined early and late mortality of ~14% in some series [ 42 , 62 ]. The introduction of the slide tracheoplasty has reduced mortality rate dramatically in some centers [ 62 ]; however, if additional intrinsic airway pathology involves distal segments, more intricate techniques are necessary to achieve a functional anatomy increasing the surgical risk (Fig.…”