[An operative case of vascular ring (Edwards III B type)]

A 28-year-old female with dysphagia due to the vascular ring (Edwards III B type) was operated successfully. Preoperative chest x-ray film showed a defect of the left first arch and deviation of the lower trachea to the left side. Esophagogram disclosed the upper thoracic esophagus stenotic and deviated left anteriorly. Arch aortogram showed the right aortic arch and aberrant left subclavian artery with the aortic diverticulum. Operation was performed through a left thoracotomy. Esophagus was squeezed by the aortic arch, aortic diverticulum and left ligamentum arteriosum. The left ligamentum arteriosum was divided. Its stump of aortic side was sutured and fixed with paravertebral pleura so that the squeeze by the diverticulum was released. The stenotic esophagus was dissected from surrounding tissue and its satisfactory distensibility was confirmed. Dysphagia disappeared after operation and postoperative esophagogram showed marked improvement of the stenosis. Eleven operated cases of this type of vascular ring in adult have been reported in Japan. Remarkable improvement of dysphagia was observed in all cases. Thus surgical treatment is recommended for cases suffering from severe dysphagia.