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Surgical management of vascular ring
Insights
Vascular rings in children often cause breathing and swallowing issues, with diagnosis delays common. Surgical intervention leads to good outcomes for most, with 76% asymptomatic post-operation.
Area of Science:
- Pediatric Surgery
- Congenital Heart Disease
- Thoracic Surgery
Background:
- Vascular rings are congenital anomalies that can cause significant respiratory and feeding problems in infants.
- Early diagnosis and surgical correction are crucial for favorable outcomes.
- Delays in diagnosis are common, potentially leading to increased morbidity.
Purpose of the Study:
- To review the surgical management and outcomes of children with vascular rings.
- To identify factors contributing to diagnostic delays.
- To evaluate the effectiveness of diagnostic methods and surgical approaches.
Main Methods:
- Retrospective review of 51 children undergoing surgery for vascular rings between 1968 and 1980.
- Analysis of patient demographics, symptoms, diagnostic methods, surgical procedures, and follow-up data.
- Evaluation of associated cardiac and noncardiac anomalies.
Main Results:
- 51 children underwent surgery for various vascular rings; 11 had associated anomalies.
- Common symptoms included stridor and recurrent infections, with diagnosis delays noted in many.
- Barium swallow was the primary diagnostic tool, though limitations were observed.
- 76% of patients were asymptomatic at follow-up; severe tracheomalacia was linked to the two deaths.
Conclusions:
- Vascular rings require timely diagnosis and appropriate surgical intervention.
- While barium swallow is useful, other methods may be needed for specific diagnoses like innominate artery compression.
- Surgical outcomes for vascular rings are generally favorable, but associated conditions like tracheomalacia can impact results.
Abstract:
Between 1968 and 1980, 51 children had an operation for various forms of vascular ring. Additional cardiac malformations were present in five patients, and six had noncardiac congenital anomalies. Although symptoms started within the first month of life in 39 infants, only 16 came to operation under three months of age, and a delay of more than six months occurred in 15. Stridor, often life-threatening, and recurrent infections were the most common symptoms, but dysphagia was also important. The reasons for delay in diagnosis are discussed. Barium swallow provided the diagnosis in 44 patients and suggested it in a further four patients. Innominate artery compression of the trachea was not diagnosed by barium swallow. Operations of various types were performed. Accuracy in diagnosis is important because not all patients could be treated through the classic left thoracotomy. Severe tracheomalacia was responsible for the only two deaths in the series; one of these had tracheostomy performed in the referring hospital, the second child also had Fallot's tetralogy. The large majority of the patients have done well, 76% being asymptomatic at follow-up. Minimal to moderate stridor persists among the remainder to the present time.