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The presentation and management of vascular rings: an otolaryngology perspective

Rahul K Shah1, Bassem N Mora, Emile Bacha

  • 1Division of Otolaryngology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA. reza.rahbar@childrens.harvard.edu

International Journal of Pediatric Otorhinolaryngology
|October 13, 2006
PubMed

Insights

Vascular rings in children commonly cause airway and feeding problems. Early diagnosis with imaging and bronchoscopy guides surgical release, with minimally invasive options available.

Area of Science:

  • Pediatric Surgery
  • Cardiovascular Surgery
  • Thoracic Surgery

Background:

  • Vascular rings are congenital anomalies where the great arteries form a ring around the trachea and esophagus.
  • These anomalies can lead to significant respiratory and feeding difficulties in infants and children.

Purpose of the Study:

  • To review the clinical presentation and natural history of pediatric patients diagnosed with vascular rings.
  • To establish management guidelines for children with vascular rings.

Main Methods:

  • Retrospective chart review of patients diagnosed with vascular rings at a tertiary care pediatric medical center.
  • Data collected from 1991 to 2002, including patient demographics, symptoms, diagnostic studies, and surgical interventions.

Main Results:

  • 37 males and 27 females were diagnosed with vascular rings.
  • 91% of patients presented with airway symptoms (e.g., stridor, recurrent infections) and 47% with esophageal symptoms (e.g., dysphagia).
  • Common diagnostic tools included echocardiography (96%), chest X-ray (93%), and barium swallow (75%). Surgical management involved open (n=25) and thoracoscopic (n=39) approaches, with an 8% rate of recurrent laryngeal nerve injury.

Conclusions:

  • Children with vascular rings typically present with respiratory and/or feeding issues.
  • Diagnostic workup should involve chest X-ray, echocardiography, barium swallow, and direct laryngoscopy/bronchoscopy.
  • Surgical intervention is indicated upon diagnosis, with both open and minimally invasive (thoracoscopic, robotic-assisted) options available.
Abstract

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