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Vascular Ring; Spectrum of Pathologies and Scenarios for Diagnosis and Management

Received: 27 June 2020     Accepted: 9 July 2020     Published: 4 December 2020
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Abstract

Background: Vascular rings represent approximately 1% of all congenital cardiac anomalies, with Edward’s classification being the first to outline them into a complete or partial vascular ring. A Complete ring is a combination of patent vessels, atretic vascular segments or ligamentous structures. Methods: We reviewed patients` records from our Pediatric Cardiac Surgery Unit, over 10 years. We encountered 63 patients from January 2009 to January 2019. Our patients were 57 (90.5%) complete vascular rings, 5 (7.9%) pulmonary artery slings, and 1 (1.6%) patient with innominate artery compression. Results: The age of our Patients ranged from 2 to 57 months (mean 16.25±1.3 m), weight ranges from 3k to 26k (mean 9.87±0.8kg). Males were 38 (60.3%) and male: female ratio was 1.5:1. In our series various types of vascular rings were encountered; Double Aortic Arch was the right dominant arch variant in 25 (53.2%) and left arch dominant in 7 (14.9%) whilethe co-dominant variant was 15 (31.9%). Fifty-seven cases of vascular rings operated through left posterolateral thoracotomy. Fivecases of pulmonary artery sling (7.9%) operated by median sternotomy and one case (1.6%) of innominate artery compression. No reported intraoperative mortality in our study. Conclusion: Vascular ring is a rare anomaly that needs suspicion for diagnosis. The operative strategy relies on extensive dissection and division of the non-dominant arch and division of the ligamentum, freeing all fibrous bands between the arch and esophagus and trachea. For augmented results; we need collaboration from pediatricians and pulmonologists who must be aware of such anomalies.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 6)
DOI 10.11648/j.ijcts.20200606.12
Page(s) 70-74
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Anomaly, Arch, Sling, Ring, Compression

References
[1] Sanjeev Sharma, Jeri L Dobbs and Adnan Cobanoglu: Surgical Correction of Vascular Ring Anomalies. Asian Cardiovascular and Thoracic Annals, 2000; 8: 344.
[2] Hanneman K., Newman B., Chan F.: Congenital Variants and Anomalies of the Aortic Arch. Radio Graphics, 2017; 37 (1), 32-51.
[3] Raghavan Subramanyan, Poorthirikovil Venugopalan and Ravi Narayan: Vascular Rings: An important Cause of Persistent Respiratory Symptoms in Infants and Children. Indian Pediatrics, 2003; 40: 951-957.
[4] Backer CL, Constantine Mavroudis, Cynthia K. Rigsbyetal: Trends in vascular ring surgery. J Thorac Cardiovasc Surg, 2005; 129: 1339-1347.
[5] Ronald K. Woods, Ronald J. Sharp, George W. Holcombetal: Vascular anomalies and tracheoesophageal compression: a single institution’s 25-yearexperience. Ann Thorac Surg, 2001; 72: 434-438.
[6] Van Son JAM, Julsrud PR, Hagler D Jetal: Surgical treatment of vascular rings: the Mayo Clinic experience. Mayo Clin Proc, 1993; 68: 1056–1063.
[7] Rahul K. Shah, Bassem N. Mora, Emile Bachaetal: The presentation and management of vascular rings: An otolaryngology perspective. International Journal of Pediatric Otorhinolaryngology, 2007; 71: 57-62.
[8] Khalfan Alsenaidi, Rebecca Gurofskya, Tara Karamlouetal: Management and Outcomes of Double Aortic Arch in 81Patients, Pediatrics, 2006; 118: 1336.
[9] Mustafa Kir, Gul Sagin Saylam and Ulas Karadas: Vascular Rings: Presentation, Imaging Strategies, Treatment and Outcome, Pediatric Cardiology Media, 2012; 33: 607-617.
[10] Xin Chen, Yanjuan Qu and Zhi-Yuan Peng: Clinical value of multi-slice spiral computed tomography angiography and three-dimensional reconstruction in the diagnosis of double aortic arch. Exp Ther Med, 2014; 8: 623–627.
[11] Bai Song, LI Xiao-feng, Liu Cai-xiaetal: Surgical treatment for vascular anomalies and tracheoesophageal compression. Chin Med J, 2012; 125: 1504-1507.
[12] Yoon Jung Suh, Gi Beom Kim, Bo Sang Kwonetal: Clinical Course of Vascular Rings and Risk Factors Associated with Mortality. Korean Circ J, 2012; 42: 252–258.
[13] Song Zw, Xu Cy, Ge W.: The diagnostic value of MSCT multi-dimensional reconstructions for congenital vascular ring with tracheal stenosis. Zhonghua.
[14] Yi Xue Za Zhi, 2011; 91: 619–622.
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  • APA Style

    Mostafa Elhelali, Mohamed-Adel Elgamal, Ahmed Mostafa, Hysam Abdelmohty, Walid Hassan. (2020). Vascular Ring; Spectrum of Pathologies and Scenarios for Diagnosis and Management. International Journal of Cardiovascular and Thoracic Surgery, 6(6), 70-74. https://doi.org/10.11648/j.ijcts.20200606.12

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    ACS Style

    Mostafa Elhelali; Mohamed-Adel Elgamal; Ahmed Mostafa; Hysam Abdelmohty; Walid Hassan. Vascular Ring; Spectrum of Pathologies and Scenarios for Diagnosis and Management. Int. J. Cardiovasc. Thorac. Surg. 2020, 6(6), 70-74. doi: 10.11648/j.ijcts.20200606.12

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    AMA Style

    Mostafa Elhelali, Mohamed-Adel Elgamal, Ahmed Mostafa, Hysam Abdelmohty, Walid Hassan. Vascular Ring; Spectrum of Pathologies and Scenarios for Diagnosis and Management. Int J Cardiovasc Thorac Surg. 2020;6(6):70-74. doi: 10.11648/j.ijcts.20200606.12

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  • @article{10.11648/j.ijcts.20200606.12,
      author = {Mostafa Elhelali and Mohamed-Adel Elgamal and Ahmed Mostafa and Hysam Abdelmohty and Walid Hassan},
      title = {Vascular Ring; Spectrum of Pathologies and Scenarios for Diagnosis and Management},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {6},
      number = {6},
      pages = {70-74},
      doi = {10.11648/j.ijcts.20200606.12},
      url = {https://doi.org/10.11648/j.ijcts.20200606.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20200606.12},
      abstract = {Background: Vascular rings represent approximately 1% of all congenital cardiac anomalies, with Edward’s classification being the first to outline them into a complete or partial vascular ring. A Complete ring is a combination of patent vessels, atretic vascular segments or ligamentous structures. Methods: We reviewed patients` records from our Pediatric Cardiac Surgery Unit, over 10 years. We encountered 63 patients from January 2009 to January 2019. Our patients were 57 (90.5%) complete vascular rings, 5 (7.9%) pulmonary artery slings, and 1 (1.6%) patient with innominate artery compression. Results: The age of our Patients ranged from 2 to 57 months (mean 16.25±1.3 m), weight ranges from 3k to 26k (mean 9.87±0.8kg). Males were 38 (60.3%) and male: female ratio was 1.5:1. In our series various types of vascular rings were encountered; Double Aortic Arch was the right dominant arch variant in 25 (53.2%) and left arch dominant in 7 (14.9%) whilethe co-dominant variant was 15 (31.9%). Fifty-seven cases of vascular rings operated through left posterolateral thoracotomy. Fivecases of pulmonary artery sling (7.9%) operated by median sternotomy and one case (1.6%) of innominate artery compression. No reported intraoperative mortality in our study. Conclusion: Vascular ring is a rare anomaly that needs suspicion for diagnosis. The operative strategy relies on extensive dissection and division of the non-dominant arch and division of the ligamentum, freeing all fibrous bands between the arch and esophagus and trachea. For augmented results; we need collaboration from pediatricians and pulmonologists who must be aware of such anomalies.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Vascular Ring; Spectrum of Pathologies and Scenarios for Diagnosis and Management
    AU  - Mostafa Elhelali
    AU  - Mohamed-Adel Elgamal
    AU  - Ahmed Mostafa
    AU  - Hysam Abdelmohty
    AU  - Walid Hassan
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    DO  - 10.11648/j.ijcts.20200606.12
    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 70
    EP  - 74
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20200606.12
    AB  - Background: Vascular rings represent approximately 1% of all congenital cardiac anomalies, with Edward’s classification being the first to outline them into a complete or partial vascular ring. A Complete ring is a combination of patent vessels, atretic vascular segments or ligamentous structures. Methods: We reviewed patients` records from our Pediatric Cardiac Surgery Unit, over 10 years. We encountered 63 patients from January 2009 to January 2019. Our patients were 57 (90.5%) complete vascular rings, 5 (7.9%) pulmonary artery slings, and 1 (1.6%) patient with innominate artery compression. Results: The age of our Patients ranged from 2 to 57 months (mean 16.25±1.3 m), weight ranges from 3k to 26k (mean 9.87±0.8kg). Males were 38 (60.3%) and male: female ratio was 1.5:1. In our series various types of vascular rings were encountered; Double Aortic Arch was the right dominant arch variant in 25 (53.2%) and left arch dominant in 7 (14.9%) whilethe co-dominant variant was 15 (31.9%). Fifty-seven cases of vascular rings operated through left posterolateral thoracotomy. Fivecases of pulmonary artery sling (7.9%) operated by median sternotomy and one case (1.6%) of innominate artery compression. No reported intraoperative mortality in our study. Conclusion: Vascular ring is a rare anomaly that needs suspicion for diagnosis. The operative strategy relies on extensive dissection and division of the non-dominant arch and division of the ligamentum, freeing all fibrous bands between the arch and esophagus and trachea. For augmented results; we need collaboration from pediatricians and pulmonologists who must be aware of such anomalies.
    VL  - 6
    IS  - 6
    ER  - 

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Author Information
  • Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

  • Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

  • Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

  • Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

  • Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

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