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Published on: September 13, 2020
Long-term Outcomes Following Thoracoscopic Division of Vascular Rings
Hannah C Cockrell1, Eustina G Kwon1, Liya Savochka2
1Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
Thoracoscopic division of vascular rings, excluding Kommerell's diverticulum resection, provides significant long-term relief from breathing and swallowing issues in pediatric patients. This minimally invasive approach demonstrates excellent outcomes for common vascular ring types.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Vascular rings are congenital anomalies causing compression of the trachea and esophagus.
- Symptoms include dysphagia, chronic cough, and respiratory distress.
- Surgical intervention aims to alleviate these compressive symptoms.
Purpose of the Study:
- To evaluate long-term symptomatic improvement in pediatric patients after thoracoscopic division of vascular rings.
- To assess the efficacy of vascular ring division without Kommerell's diverticulum resection.
Main Methods:
- Retrospective chart review of pediatric patients who underwent thoracoscopic vascular ring division (01/2007-12/2022).
- Exclusion criteria included Kommerell's diverticulum resection.
- Long-term follow-up data collected via structured telephone interviews.
Main Results:
- 88% of patients experienced postoperative symptom improvement, with most reporting no or minor residual symptoms.
- Dysphagia (42%) and chronic cough (21%) were the most frequent preoperative complaints.
- Median follow-up was 95 months, with only one patient reporting symptom worsening.
Conclusions:
- Thoracoscopic division of vascular rings, particularly those involving an aberrant left subclavian artery (LSCA) or atretic arch, is effective for long-term symptom resolution.
- This approach, without Kommerell's resection, adequately addresses breathing and swallowing problems caused by vascular rings.
