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Published on: October 20, 2017
Vascular rings and slings. Diagnosis and surgical treatment of 49 patients
Insights
Surgical intervention for symptomatic vascular rings and slings in 49 infants effectively treated tracheal and esophageal compression. This study outlines diagnostic and surgical strategies for these rare congenital anomalies.
Area of Science:
- Cardiology
- Pediatric Surgery
- Thoracic Surgery
Background:
- Vascular rings and slings are rare congenital anomalies causing tracheal and esophageal compression in infants.
- Symptoms range from respiratory distress to feeding difficulties, necessitating timely diagnosis and intervention.
Purpose of the Study:
- To present a diagnostic scheme for accurate morphological definition of various vascular anomalies.
- To outline surgical procedures based on personal experience for symptomatic infants.
Main Methods:
- Retrospective review of 49 infants with symptomatic vascular rings and slings requiring surgery (1973-1984).
- Classification of anomalies including double aortic arch, anomalous innominate artery, aberrant subclavian arteries, and pulmonary sling.
- Description of diagnostic approaches and surgical outcomes.
Main Results:
- Forty-eight of 49 infants survived surgery with follow-up ranging from 3 months to 11 years.
- Specific anomalies identified: double aortic arch (20), anomalous innominate artery (13), aberrant subclavian arteries (14), and pulmonary sling (2).
- One hospital death occurred in a patient with severe tracheal compression and brain damage.
Conclusions:
- A structured diagnostic and surgical approach can lead to successful outcomes in infants with vascular rings and slings.
- Accurate morphological definition is crucial for tailoring surgical interventions.
- Management of associated severe tracheomalacia may require tracheal resection and anastomosis.
Abstract:
Forty-nine infants with symptomatic vascular rings and slings, ranging in age from 20 days to 12 months, required surgical intervention between 1973 and 1984. The following anomalies were present in our patients: double aortic arch with left descending aorta (14), double aortic arch with right descending aorta (6), anomalous innominate artery (13), right aortic arch with aberrant left subclavian artery (4), left aortic arch with aberrant right subclavian artery (10), aberrant left pulmonary artery (pulmonary sling) (2). All the babies had symptoms related to compression of the trachea and/or esophagus. Four patients required temporary tracheostomy in the early postoperative period; 1 patient, affected by a pulmonary sling, required tracheal resection and anastomosis, for severe tracheomalacia. There was one hospital death in a patient with severe tracheal compression from an anomalous innominate artery and brain damage as a result of metabolic problems. Forty-eight patients survived and follow-up ranged from 3 months to 11 years. For each type of vascular anomaly encountered, and based on personal experience, we have outlined a diagnostic scheme allowing an accurate morphological definition and a subsequent surgical procedure.
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