Materiały źródłowe

• #1 Vascular Rings Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/426233-treatment

  Surgical division of a vascular ring is indicated in all symptomatic patients. To avoid serious complications such as sudden death or significant tracheal or bronchial damage, surgery should not be delayed, especially in patients with symptoms of airway compression. […] Individuals who have no symptoms from a vascular ring may not require surgical intervention. […] Surgical division of symptomatic vascular rings is the only appropriate form of therapy. Surgery should be performed promptly after the diagnosis is made, especially in patients with stridor, apnea, or other symptoms of respiratory distress. Delay in operative intervention can result in complications of a serious nature. […] No medical therapy exists for the definitive treatment of vascular rings. Preoperatively, the patient should be given adequate nutritional support as well as general respiratory care and appropriate treatment of any respiratory tract infection. Surgery should not be delayed in the presence of a respiratory tract infection, because the division of the ring allows more adequate and complete clearing of respiratory secretions.

• #1 Vascular Rings Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/426233-treatment

  Video-assisted thoracoscopic surgery (VATS) techniques have been used for some pediatric thoracic surgical procedures. Several centers have successfully employed this technology for patent ductus arteriosus ligation. Although some reported use of VATS for vascular ring division exists, this remains a controversial area. […] Because of the constraints imposed by video-assisted techniques, the surgeon may have difficulty ascertaining when complete occlusion of the arch by the vascular clips has occurred. Given that current open techniques provide excellent operative results with extremely low mortality and low morbidity, minimally invasive methods will have to provide the same assurance of safety and efficacy in order to be applicable. […] Immediate postoperative management after division of a vascular ring is performed in an intensive care unit (ICU). The majority of patients can be extubated immediately or within a short time after the operation.

• #1 Vascular Rings Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/426233-treatment

  About 10% of infants may continue to have noisy breathing for a while after the surgical procedure; it is important to inform the child’s parents of this possibility. In some case, total relief of symptoms may take several months to 1 year. […] Serious surgical complications are rare in most reported surgical series of vascular ring division. Most complications associated with these problems occur in the preoperative setting and may even occur before the diagnosis is known. […] Most patients are essentially asymptomatic within a few weeks after surgery and can resume activity and feedings as tolerated.

• #2 Vascular rings and slings – UpToDate

  https://www.uptodate.com/contents/vascular-rings-and-slings

  Vascular rings are congenital anomalies of the aortic arch that result in compression of the tracheobronchial tree and/or esophagus, leading to respiratory and gastrointestinal symptoms. […] The different forms of vascular rings and slings and their clinical manifestations, diagnosis, and treatment are discussed here. […] TREATMENT […] Surgery […] Indications […] Division for vascular rings […] Repair for pulmonary artery sling […] Surgery for innominate artery compression syndrome […] No role for pharmacologic treatment.

• #3 Vascular Ring Surgery & Repair: Expert Care at Rady Children’s | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/aerodigestive-vascular-ring-program/

  Rady Childrens Hospital in San Diego specializes in the treatment of vascular rings, offering various surgical and non-surgical options under the leadership of Matthew Brigger, MD, chief of the Division of Otolaryngology, and John Nigro, MD, chief of the Division of Cardiac Surgery and Director of the Heart Institute. […] At Rady Childrens, our specialists are here to help identify and treat vascular rings whether it’s a complete vascular ring or an incomplete one. […] Rady Childrens Hospital provides a comprehensive, tailored approach for each patient through our Aerodigestive Vascular Ring Program. […] If your child requires vascular ring repair, our team carefully considers factors like a left aortic arch, left subclavian artery, or right subclavian artery to plan the most effective approach.

• #3 Vascular Ring Surgery & Repair: Expert Care at Rady Children’s | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/aerodigestive-vascular-ring-program/

  At Rady Childrens Hospital, we believe that not all vascular rings need surgical repair, especially if a child is asymptomatic. However, for children experiencing symptoms, the primary treatment is surgery. Surgery is typically successful, and most children recover fully. The goal is to remove the abnormal ring of blood vessels that is compressing the trachea and esophagus. […] If surgery is recommended, the cardiovascular surgeon will decide the best approach after reviewing all imaging. Approaches may include: A thoracotomy (accessing the chest wall from the side between the ribs) or A sternotomy (dividing the breastbone to access the chest cavity). […] Techniques to resect the vascular ring can include takedown of the vessels or ligaments, re-implanting an abnormal subclavian artery, or re-positioning the aorta.

• #4 Vascular Ring Anomaly | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/v/vascular-ring

  Surgery to divide the vascular ring is indicated in all symptomatic cases. […] There is a low risk with surgery to divide a vascular ring. […] The goal of surgery for vascular rings is to make sure blood can flow through the vessels freely. When the ring is open in at least one direction, symptoms will be relieved. […] In most cases the surgery is done using an small cut on the left side of the chest. This allows entry between the ribs. In the case of double aortic arch, the left side of the ring (which is usually the smaller side) is divided where it is putting pressure on the esophagus. […] With a right aortic arch and abnormal left subclavian artery, the ligamentum arteriosum (a ligament that was a blood vessel during fetal life) is divided between the descending aorta and the pulmonary artery. Hospitalization after surgery is usually a day or two. […] Complete relief of symptoms may show up right away after surgery. […] Improvement of swallowing symptoms in such cases may be seen gradually.

• #5 Vascular Ring | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/vascular-ring

  Vascular rings require surgery (not open heart) if there are symptoms. In most cases, the surgeon makes an incision on the left side of the chest and goes between the ribs to access the area. […] The surgeon will cut and stitch closed one of the arches (usually the left) so the aorta no longer encircles or puts pressure on the trachea or esophagus. […] The surgeon divides the ligamentum arteriosum so that it no longer constricts the trachea or esophagus. (The right aortic arch remains, as a person can live with this irregularity.) […] In some cases, a child has no symptoms of vascular ring and the condition is discovered during an unrelated medical test, procedure or evaluation. Instead of surgery, a Cardiac Center team will monitor the child to make sure symptoms dont appear and the condition isnt harming the child’s health. […] The procedure to correct vascular ring is considered low risk. In cases where there are symptoms as outlined above, surgery is recommended.

• #6 Vascular ring Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/vascular-ring

  Surgery is usually performed as soon as possible on children with symptoms. The goal of surgery is to split the vascular ring and relieve pressure on the surrounding structures. The procedure is usually done through a small surgical cut in the left side of the chest between the ribs. […] Changing the child’s diet may help relieve the digestive symptoms of vascular ring. The provider will prescribe medicines (such as antibiotics) to treat any respiratory tract infections, if they occur. […] Children who do not have symptoms may not need treatment but should be carefully monitored to make sure the condition does not become worse.

• #7 Vascular ring | Iowa Head and Neck Protocols

  https://gme.medicine.uiowa.edu/iowaprotocols/vascular-ring

  General treatment principles […] Each anomaly has a unique repair procedure performed by cardiothoracic surgery. In general, the ligamentum/arteriosum is severed, the diverticulum of Kommerell removed and the vessels rearranged as necessary. This sometimes involves aortopexy and/or cardiopulmonary bypass. […] The decision for surgery is a joint decision between multiple actors. It will often not be clear that dysphagia or airway difficulty are a direct result of vascular compression. Ultimately, cardiothoracic surgery is responsible to the decision to proceed with treatment but it often involves discussions with pulmonology, cardiology, otolaryngology and the family. […] Mild symptoms may sometimes be observed (Loomba 2016) […] Surgical outcomes are generally very good (70-90% resolution). Dysphagia almost always resolves and persistent problems after initial repair are often related to tracheal anomalies. Persistent post-operative aerodigestive concerns range from mild stridor to tracheostomy and positive pressure ventilation.

• #8 Vascular Ring and Airway Program | Boston Children’s Hospital

  https://www.childrenshospital.org/programs/vascular-ring-and-airway

  The recommendations from our conference can include monitoring symptoms, obtaining additional testing, or pursuing a surgical repair of the vascular ring. […] If surgery is recommended, we often recommend baseline studies. […] Surgery is pursued when our team and a family together agree that the benefits of an operation outweigh the risks. […] The exact surgical plan is determined based on a patients vascular ring anatomy and areas of compression to the esophagus and airway. […] It is important to note that the final surgical recommendation is patient-specific and based on each childs anatomy. […] Here are some of the proven, cutting-edge surgical techniques we offer to treat vascular rings: Complete resection of the diverticulum of Kommerell, Descending aortopexy, Rotational esophagoplasty, Posterior tracheobronchopexy, Aortic arch reconstruction (aortic uncrossing and aortic relocation). […] Our team also closely monitors patients over the long term after surgery. […] Following discharge, we will closely follow your child through in-person or virtual visits, ensuring they are recovering well and so that we can be available to your family as needed.

• #9 Expertise in the nuances of diagnosis, management and surgery for vascular rings – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/pediatrics/news/expertise-in-the-nuances-of-diagnosis-management-and-surgery-for-vascular-rings/mac-20530282

  Vascular rings are a group of diagnoses present at birth caused by abnormal development of the brachial arch system, which results in a ring of vessels encircling and constricting the airway and esophagus. […] Double aortic arch repair is usually done in infants to divide the additional arch from the side (chest). […] Right arch with aberrant left subclavian in adults requires vascular surgery rerouting the subclavian to come off the carotid artery via an incision in the neck. […] When causing significant symptoms, left arch with aberrant right subclavian is usually repaired by vascular surgery rerouting the subclavian to come off the carotid artery via an incision in the neck. […] Surgical intervention is nearly always recommended to release vascular rings. […] Corrective surgery for those with a fetal diagnosis is typically performed when patients are between 6 months and 2 years old.

• #9 Expertise in the nuances of diagnosis, management and surgery for vascular rings – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/pediatrics/news/expertise-in-the-nuances-of-diagnosis-management-and-surgery-for-vascular-rings/mac-20530282

  Mayo Clinic pediatric cardiac surgeons are experienced in various surgical treatment approaches for patients of all ages. […] Surgical approaches include the following: Double arch repair is usually done in infants to divide the additional arch from the side (chest). No bypass is required. […] Right arch with aberrant left subclavian in young children is repaired from the side (chest). The subclavian is rerouted by attaching it to the carotid artery, and the ring is released. […] When causing significant symptoms, left arch with aberrant right subclavian is usually repaired via vascular surgery rerouting the subclavian to come off the carotid artery via an incision in the neck and is followed by resection of the residual stump from the side (left chest). […] Right arch with aberrant left subclavian in adults requires vascular surgery rerouting the subclavian to come off the carotid artery via an incision in the neck and is followed by replacing that part of the aorta on bypass from the side (right chest). […] „We have found that, in general, surgical repairs have excellent outcomes and minimize complications related to chronic airway and esophageal compression,” says Dr. Stephens.

• #10 Vascular Rings: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/426233-overview

  Surgical division of a vascular ring is indicated in all symptomatic patients. To avoid serious complications, surgery should not be delayed, especially in patients with symptoms of airway compression. Individuals who have no symptoms from a vascular ring may not require surgical intervention. Surgical repairs in most cases can be performed successfully and without long-term morbidity (see Treatment). […] About 95% of patients who undergo surgical correction of a vascular ring survive for long periods, and most of these are soon relieved of their symptoms. In those infants with no intracardiac or extracardiac defects, surgery for vascular rings carries essentially no mortality. […] In a series reported by Backer et al, reoperation proved necessary for 26 of 300 patients who had undergone surgical intervention for vascular rings. The four primary indications for reoperation were Kommerell diverticulum (18 patients), circumflex aorta (2 patients), residual scarring (2 patients), and tracheobronchomalacia necessitating aortopexy (4 patients).

• #10 Vascular Rings: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/426233-overview

  Naimo et al reported long-term outcomes of complete vascular ring division in 132 children from a 36-year experience at a single institution (median follow-up, 11.4 y; range, 44 d to 36 y). In-hospital mortality was 1.5% (2/132), and no late deaths occurred. Overall survival was 98.3 1.2% at 20 years. After surgical treatment, three patients experienced persistent tracheal compression, and 16 had tracheomalacia. The freedom-from-reoperation rate was 88.6 4.0%. None of the patients required tracheal surgery during the follow-up period. […] Franois et al assessed early and late outcomes (mean follow-up, 7.8 5.8 y) in 62 patients (median age, 1 y) who underwent surgical treatment of a vascular ring (most commonly a double aortic arch [53%]). Median extubation time was 4 hours, and median hospital stay was 5 days. Early mortality was 8% and was associated with the anatomic diagnosis, concomitant anomalies, and the need for preoperative intubation. At 1 month, 63% of patients were free of residual symptoms; at 6 months, 82% were. At final follow-up, the rate of freedom from inhalation therapy was 82%.

• #11 Vascular Ring | Norton Children’s

  https://nortonchildrens.com/services/cardiology/conditions/congenital-heart-disease/vascular-rings/

  A vascular ring happens when the aorta or its branches form a complete ring around the trachea (windpipe) and the esophagus, the tube that leads from the throat to the stomach. […] A vascular ring is a birth defect that can cause issues with breathing and eating. Children who have symptoms from vascular rings will need surgery. The procedure is not open heart surgery but does involve surgery inside the chest. In many cases, the surgeon makes a small incision on the left side of the chest and goes between the ribs to make the repair. […] The surgeon will cut and stitch closed one of the arches, usually the left, so the aorta no longer encircles or puts pressure on the trachea or esophagus. […] The surgeon divides the ligamentum arteriosum so that it no longer puts pressure on the trachea or esophagus. The right aortic arch remains, as a person can live with this type of defect.

• #12 Treatments and Services | Vascular Ring and Aortic Uncrossing Program

  https://www.cincinnatichildrens.org/service/v/vascular-ring/services

  Many vascular rings can be treated with routine surgery. Complex vascular rings sometimes require a more delicate repair called aortic uncrossing surgery. This procedure specifically treats circumflex aorta and repeat vascular rings for patients with persistent symptoms after surgery. […] Your surgeon will use minimally invasive techniques to divide the vascular ring. This ensures free blood flow and relieves pressure on the airway. […] If a vascular ring is present, that repair is usually made first. If symptoms persist, your child may need a surgeon to perform an aortic uncrossing. […] The procedure moves the aortic arch to the same side of the body as the descending aorta. This relieves airway pressure and makes breathing easier. […] If your child received vascular ring repair and still has symptoms, we can help. […] Our 3D modeling and surgery planning lets your care team create the right procedure to stop airway compression. […] Procedures may also include tracheal slide repair to treat narrowing of the trachea. […] We follow multiple pathways and protocols for rapid recovery and a safe return home.

• #13 Vascular Ring | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/vascular-ring

  Boston Children’s is one of the few hospitals to repair vascular rings with a combination of these procedures in one comprehensive surgical procedure. Treating a child with just one operation ensures that the condition is treated thoroughly and prevents the need for future procedures. […] Our surgical approach involves addressing the vascular ring itself as well as assessing the need for additional airway or esophageal interventions to ensure a durable repair. […] In addition to the vascular ring repairs above, we also have experience with several other procedures to address additional sources of compression beyond the vascular ring itself. […] If a patient’s surgery did not address the vascular ring completely, they may have recurrent symptoms and require another operation. […] We are one of the few hospitals in the world that offers sternal reconstruction to relieve crowding between a patient’s sternum and spine, which can result in compression of various structures in the chest, such as the airway, esophagus, and vascular structures.

• #14 Vascular Rings – Seattle Children’s

  https://www.seattlechildrens.org/conditions/vascular-rings/

  Some children with vascular rings need treatment, and some do not. […] Children who have symptoms need surgery. During surgery, your childs surgeon cuts the rings so they do not press on the trachea or esophagus. […] Our heart team works closely with Seattle Childrens general pediatric surgeons to treat vascular rings with as little surgery as possible. […] We developed a team that can treat some children with vascular rings using thoracoscopic surgery. This means using a small camera and microsurgical tools placed into the chest through tiny holes. This may reduce the recovery time after surgery. […] Your child may need medicine to help with their symptoms until they can have surgery. […] If your child has vascular rings but no symptoms, your childs doctor will want to check your child on a regular basis to see if any symptoms start to develop.

• #15 Vascular Aortic Arch Ring – MD Searchlight

  https://mdsearchlight.com/heart-health/vascular-aortic-arch-ring/

  Recent advancements have led to alternative surgical techniques, including video-assisted thoracoscopic surgical techniques and endoscopic robotic-assisted surgical techniques. These new methods, being used in advanced treatment centers, show promising initial results, including shorter hospital stays.

• #15 Vascular Aortic Arch Ring – MD Searchlight

  https://mdsearchlight.com/heart-health/vascular-aortic-arch-ring/

  Another condition, called Double Aortic Arch, is managed by determining the point of surgical division using preoperative imaging. This is usually a rigid (atretic) segment in the smaller of the two arches, which is most often the left-sided arch. A left-sided posterolateral thoracotomy is performed where the ligamentum or ductus needs to be divided to relieve symptoms. […] For Pulmonary Artery Sling, the patient is placed on a machine to support the heart and lungs function (cardiopulmonary bypass), and the surgeon accesses the area through a midline sternotomy approach (incision in the center of the chest). In patients with pressure on the outside of the trachea without fixed narrowing, relocation of the left pulmonary artery to the front of the trachea is done. If there is a complete ring of the trachea, the affected portion is usually removed.

• #16 Vascular Rings | SpringerLink

  http://link.springer.com/10.1007/978-3-662-43588-5_53

  Patients often present with symptoms in the first few months of life and require surgery early in life. […] In patients with pulmonary artery sling, repair is undertaken via median sternotomy utilizing cardiopulmonary bypass and reimplanting the left pulmonary artery onto the left side of the main pulmonary artery. If necessary, tracheal repair can be performed concurrently. […] Excellent results have been achieved in recent years without operative mortality in high-volume centers. Most of the patients are essentially free of symptoms in the long term, and only a very small number need further interventions or supportive treatment.

• #17 Pediatric vascular rings and slings | Applied Radiology

  https://appliedradiology.com/articles/pediatric-vascular-rings-and-slings

  Vascular anomalies of the aortic arch and great vessels often present in childhood with symptoms related to feeding difficulties or respiratory issues. […] Basic embryology and surgical interventions will also be reviewed. […] Patients who are symptomatic can undergo surgery where transection is directed towards the smaller arch. […] There is a high mortality rate without surgical intervention. Repair of a pulmonary artery sling consists of detaching the left pulmonary artery off of the right pulmonary artery and implanting it onto the main pulmonary artery anterior to the trachea. […] Surgery is rarely performed because this infrequently produces symptoms. When performed, surgery involves resecting the Kommerells diverticulum and reimplanting the left subclavian onto the left common carotid artery.

• #17 Pediatric vascular rings and slings | Applied Radiology

  https://appliedradiology.com/articles/pediatric-vascular-rings-and-slings

  If surgery is performed, the aberrant right subclavian artery is divided and anastamosed to the right common carotid artery. […] If symptoms are severe enough, surgical correction is performed with reimplantation/suspension of the innominate artery to the sternum. This procedure is called an aortopexy. […] However infants with double aortic arch, pulmonary sling, and innominate artery compression often present with symptoms requiring surgical intervention. Familiarity with these entities is important to ensure accurate diagnosis and management.

• #18 Editorial on “vascular ring diagnosis and management: notable trends over 25 years” – Savla – Translational Pediatrics

  https://tp.amegroups.org/article/view/14191/html

  Vascular rings due to DAA frequently become symptomatic because the ring around the trachea and esophagus is often tight. […] In contrast, vascular rings due to RAA-ALS can be asymptomatic or only have mild symptoms because the ring is relatively loose. […] When the decision is made to refer a patient with significant or persistent symptoms for surgical repair of a vascular ring, preoperative imaging with either magnetic resonance imaging (MRI) or computed tomography (CT) is essential to provide an accurate and complete diagnosis. […] This is beneficial for some patients who truly become symptomatic and results in a timely surgical repair. […] However, a fetal diagnosis of vascular ring should not be the only indication for surgery. […] Therefore, the clinician should carefully weigh the risks and benefits of operating on patients with asymptomatic vascular rings.

• #19 Vascular Rings | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/vascular-rings/

  Lurie Childrens surgeons have pioneered several procedures to advance the methods used to correct many kinds of vascular rings. Vascular rings must be surgically corrected. This can be done either through a left thoracotomy or a median sternotomy. If a left thoracotomy is used, you should expect a 2-day hospital stay. A median sternotomy requires cardiopulmonary bypass and therefore, has a longer recovery of 5-7 days. […] To learn more about treatment offered at Lurie Children’s, visit our Vascular Rings Program page. […] To help prepare families for their care with Lurie Children’s Heart Center, we have compiled a list of resources about treatment and recovery. Learn how to get ready for an inpatient stay or outpatient visit, and read about our support services for patients and families.

• #20 Vascular rings and slings – UpToDate

  http://www.uptodate.com/contents/vascular-rings

  Surgery […] – Indications […] – Division for vascular rings […] – Repair for pulmonary artery sling […] – Surgery for innominate artery compression syndrome […] […] […] No role for pharmacologic treatment

• #21 Vascular Rings Program | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/vascular-rings-program/

  Lurie Children’s Vascular Ring Program treats children with severe vascular rings, using innovative and proven surgical methods to relieve pressure on the trachea and esophagus. […] We have pioneered procedures such as Kommerells diverticulum excision, along with division of an associated vascular ring, to prevent enlargement of the diverticulum over time with recurrence of symptoms of obstructed breathing or difficulty swallowing. […] The results of vascular ring surgery are excellent we have not had an operative mortality rate in the past 30 years and more than 90% of our patients see their symptoms resolve. […] The three Lurie Childrens Heart Center attending surgeons are American Board of Thoracic Surgery-certified Thoracic and Congenital Cardiac Surgeons. They have expertise in all aspects of surgery for repair of vascular rings.

• #22 Vascular ring – UF Health

  https://ufhealth.org/conditions-and-treatments/vascular-ring

  Surgery is usually performed as soon as possible on children with symptoms. The goal of surgery is to split the vascular ring and relieve pressure on the surrounding structures. The procedure is usually done through a small surgical cut in the left side of the chest between the ribs. […] Changing the child’s diet may help relieve the digestive symptoms of vascular ring. The provider will prescribe medicines (such as antibiotics) to treat any respiratory tract infections, if they occur. […] Children who do not have symptoms may not need treatment but should be carefully monitored to make sure the condition does not become worse. […] Surgery works well in most cases and often relieves symptoms right away. Severe breathing problems may take months to go away. Some children may continue to have loud breathing, especially when they are very active or have respiratory infections.

• #23 Pediatric Vascular Ring | Memorial Hermann

  https://memorialhermann.org/services/conditions/pediatric-vascular-ring

  Surgery relieves most symptoms, though sometimes major breathing issues take months to disappear, as the windpipe expands to its natural shape, after having been confined by the vascular ring. When active, children may breathe loudly until vascular ring is resolved. Children should have regular checkups with their pediatric cardiologist.

• #24

  https://choc.congenital.org/?id=vascularring3

  Treatment of this defect involves the division of the ligamentum arteriosum (LA in animation). In addition, Kommerell’s diverticulum (KD) is usually removed from the left subclavian artery (also shown), which is then closed with sutures. These procedures break the constricting ring around the trachea and esophagus. […] Recovery from the repair of Vascular Ring depends on the nature of the defect and surgical procedure. However, it is usually uncomplicated, requiring a post-operative hospital stay of from 2 to 3 days. […] In severe cases, it may take as long as one year for the trachea to assume normal shape after the constriction has been removed and normal swallowing may also take some time to be established. In extreme cases, persistent tracheal narrowing after repair may require tracheostomy, an opening in the neck that allows placement of a temporary breathing tube to keep the trachea open.

• #25 Prenatal ultrasound scans showing a vascular ring | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/prenatal-ultrasound-scans-showing-vascular-ring/

  When we carried out a prenatal ultrasound scan in the Fetal Cardiology clinic, we were able to confirm that your baby has a structurally normal heart but there is an unusual arrangement of the great arteries after they have left the heart called a vascular ring. This arrangement has the potential to form a ring round the trachea (windpipe) and oesophagus (food pipe). The baby may never have any symptoms or it might gradually give rise to breathing problems and/or swallowing problems if the vascular ring squashes the oesophagus and/or trachea. […] This could present with noisy breathing or difficulty swallowing suggesting that surgery to correct the problem is needed. Sometimes the surgery is performed before symptoms develop. […] If the ring is tight enough to cause problems you may notice: Noisy breathing if the trachea is compressed; Difficulty swallowing, particularly when the baby is weaned from milk to solids, if the oesophagus is compressed.

• #26 Treatment of Symptomatic Vascular Rings in the Elderly

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1336722/

  A 76-year-old woman presented with respiratory failure that was later determined to be a result of a right aortic arch with an aberrant left brachiocephalic artery. This vascular ring compressed the trachea, requiring operative intervention. […] Symptomatic vascular rings require operative intervention. Relief of symptoms follows surgical correction, in most cases. […] Surgical intervention is indicated in all patients who present with symptomatic vascular rings. The surgical approach to these lesions can be via either thoracotomy or sternotomy. […] The acute presenting respiratory symptoms in our patient demonstrate the crucial need in such cases for airway control, which often necessitates intubation to prevent airway collapse. Furthermore, symptomatic vascular rings require operative intervention, which should not be unduly deferred due to comorbidities or advanced age, or pending extensive radiographic evaluation. In the appropriate candidate, surgery yields excellent operative results and a high probability of symptomatic improvement.

• #27 Vascular rings // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/vascular-rings

  Surgery usually is done to treat a vascular ring that presses against the trachea or esophagus. Surgery also helps prevent complications. […] During surgery, the surgeon splits the vascular ring to stop the blood vessel from pressing against the windpipe and food pipe. Depending on the type of vascular ring, one of the branches off the aorta may need to be moved. The specific type of surgery depends on the type of heart conditions present. […] People born with vascular rings need regular health checkups for life to prevent complications. It’s best to be cared for by a healthcare professional trained in congenital heart conditions. These types of doctors are called congenital cardiologists.

• #28 Vascular rings

  https://www.mymlc.com/health-information/diseases-and-conditions/v/vascular-rings/?section=Diagnosis

  Surgery is usually needed to treat vascular rings that are pressing against the trachea or esophagus and to avoid complications. Surgeons divide the vascular rings to release the vessels pressing against the trachea and esophagus. The procedure is often conducted during open surgery, but in some cases a minimally invasive approach may be used. […] Different surgical approaches may be used, depending on the specific malformation. […] Children and adults with vascular rings may need lifelong care and regular follow-up appointments with specialists to monitor their conditions. Multiple specialists, including congenital cardiologists, doctors trained in lung conditions (pulmonologists), doctors trained in digestive conditions (gastroenterologists), and doctors trained in ear, nose and throat conditions may be involved in their care.

• #29 Vascular rings – what has changed, and what do I need to know as a practitioner? | Cardiology in the Young | Cambridge Core

  https://www.cambridge.org/core/journals/cardiology-in-the-young/article/vascular-rings-what-has-changed-and-what-do-i-need-to-know-as-a-practitioner/101C8D89EFAD9C234DD6B16851D497C1

  Recently, there has been a substantial increase in the frequency of diagnosis in asymptomatic patients and on fetal echocardiogram. […] This diagnosis can prime the parents and practitioners with a possible anatomic basis for any symptoms which may potentially develop. […] The goal of surgery is alleviation of symptoms and prevention of permanent airway or oesophageal dysfunction, achieved through the relief of the compression. […] Fortunately, the current outcomes are excellent with low morbidity with a high rate of symptom resolution and freedom from reoperation. […] For those who do not experience symptomatic improvement, or have improvement with subsequent recurrent symptoms, repeating the diagnostic workup is necessary. […] Some of these may be ameliorated by further surgical intervention.

• #30 Vascular Aortic Arch Ring | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/31016

  Since all symptoms result from mechanical compression, there is no role for medical treatment, and surgical correction is the only definitive treatment available with excellent clinical outcomes. Surgery is indicated only in symptomatic individuals. […] Through a posterolateral left thoracotomy, the left-sided PDA or ligamentum or atretic segment is divided, which results in the release of the vascular ring. […] Using preoperative imaging, the site of the surgical division is selected. This is usually an atretic segment in the smaller of the two arches, which is, in most cases, the left-sided arch. […] Cardiopulmonary bypass and midline sternotomy approach are used. Relocation of the left pulmonary artery to anterior of the trachea is done in patients with extrinsic tracheal compression without fixed stenosis. […] Video-assisted thoracoscopic surgical (VATS) and endoscopic robotic-assisted surgical techniques are being used as an alternative to open thoracotomy in advanced treatment centers and show initial promising results with reduced length of stay.

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