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[Vascular ring and pulmonary loop: experience with the surgical treatment]
Insights
Vascular rings causing tracheobronchial obstruction in children were surgically treated. A right aortic arch is a key indicator of vascular rings, often without intracardiac anomalies.
Area of Science:
- Cardiovascular Surgery
- Pediatric Thoracic Surgery
- Congenital Heart Disease
Background:
- Vascular rings are congenital anomalies of the aortic arch.
- They can cause significant tracheobronchial obstruction in infants and children.
- Stridor is a common presenting symptom.
Purpose of the Study:
- To analyze the surgical management and outcomes of children with tracheobronchial obstruction due to vascular rings.
- To evaluate the diagnostic methods and surgical approaches for these conditions.
- To determine the significance of a right aortic arch in the context of vascular rings.
Main Methods:
- Retrospective analysis of 143 pediatric patients undergoing surgery for tracheobronchial obstruction.
- Diagnosis confirmed via chest radiography, esophagography, bronchoscopy, and angiography.
- Surgical intervention through posterolateral thoracotomy.
Main Results:
- Common vascular ring types included double aortic arch and right aortic arch with ligamentum arteriosum.
- No intraoperative mortality; two postoperative deaths due to severe respiratory infection.
- Right aortic arch, excluding situs inversus, was consistently associated with vascular rings.
Conclusions:
- Surgical intervention for vascular rings causing tracheobronchial obstruction is effective with low mortality.
- A right aortic arch is a highly reliable sign of a vascular ring.
- Early diagnosis and surgical correction are crucial for favorable outcomes.
Abstract:
Operation was carried out on 143 children (aged from 5 days to 16 years) for tracheobronchial obstruction caused by vascular rings. A double arch of the aorta was found in 50 patients, double arch of the aorta with atresia of the left arch--in 50 patients, right arch of the aorta with ligamentum arteriosum--in 30, left arch of the aorta with an aberrant right subclavian artery--in 10, and a pulmonary loop in 3 patients. Stridor was the main clinical manifestation of the vascular ring. The diagnosis was established by means of two-projection chest radiography and esophagography with a barium meal, bronchoscopy, and angiography. The surgical approach was gained through a posterolateral (left or right) thoracotomy. No deaths occurred during the operation. Two infants died in the postoperative period from a severe bacterial infection of the respiratory tract. On the basis of a rich clinical experience the authors came to the conclusion that the presence of a right aortic arch (except for cases with situs inversus) is always pathognomic because it either causes the appearance of a vascular ring without any intracardiac anomaly, or it may be combined with a congenital heart disease in which a vascular ring is usually not encountered (tetralogy of Fallot, truncus arteriosus communis, etc.). The authors never encountered atresia of a segment of the right aortic arch. The last-named was either patent or absent.