Vascular Rings With Tracheoesophageal Compression: Management Considerations

Area of Science:

• Cardiology
• Thoracic Surgery
• Pediatric Surgery

Background:

• Vascular rings are congenital anomalies requiring surgical intervention.
• Ann & Robert H. Lurie Children's Hospital has treated over 450 vascular ring patients.
• Surgical strategies have evolved since 1990.

Purpose of the Study:

• To review surgical strategies for vascular ring patients based on extensive clinical experience.
• To highlight the impact of preoperative imaging on surgical decision-making.
• To reduce reoperation rates in vascular ring surgery.

Main Methods:

• Preoperative cross-sectional imaging utilized in all vascular ring patients since 1990.
• Refinement of operative strategies tailored to individual patient anatomy.
• Specific attention to Kommerell diverticulum in right aortic arch and double aortic arch cases.

Main Results:

• Over 450 vascular ring patients treated.
• For right aortic arch, Kommerell diverticulum resection with left subclavian artery transfer is increasingly performed.
• For double aortic arch, Kommerell diverticulum resection is performed when present, with shorter mean length of stay (3 days) compared to right aortic arch (4.5 days).

Conclusions:

• Advanced preoperative imaging enables precise, individualized surgical techniques for vascular rings.
• Addressing Kommerell diverticulum is crucial for improving outcomes and reducing reoperations.
• Tailored surgical approaches enhance patient management for complex congenital heart anomalies.