Vascular rings in a tertiary care center: A retrospective review of clinical presentations and interventions

Table 1 Demographic and clinical characteristics of patients with vascular rings

Patient	Sex	Age at surgery	Primary diagnosis	Weight at surgery (kg)	Associated intracardiac lesions	Feeding difficulties	Failure to thrive	Other pertinent symptoms	Tracheal/esophageal position at presentation
1	M	38 months	DAA	16	None	No	No	Asthma, recurrent RTI including PNA at birth requiring 3-day ICU admission, breath-holding spells	Midline- an external indentation on the right side of the trachea with mild narrowing
2	F	17 months	RAA with aberrant LSA from DA, left retroesophageal ligamentum arteriosum	7	ASD, VSD	Yes	Yes	Voice hoarseness	Midline- no deviation; mild indentation of proximal esophagus
3	F	8 days	DAA	2.92	Large PFO	Yes	No	Recurrent RTI, stridor, perioral cyanosis	Significant tracheal narrowing with a minimum transverse tracheal diameter of 2 mm. Impression on proximal esophagus
4	F	1 month	RAA with aberrant LSA from DA, with diverticulum of Kommerell, a tiny left ductus arteriosus originating from aberrant LSA	2.8	VSD, small PFO	No	No	Recurrent RTI, stridor	Right upper lobe bronchus arising from the trachea; impingement of the right pulmonary artery along the distal carina; mild narrowing of the trachea
5	F	3 years	DAA	13	None	Yes	Yes	Chronic cough, GERD, stridor, chronic wheezing	Impression on the right side of the trachea
6	F	16 months	RAA with aberrant LSA from DA and left ligamentum arteriosum	8	ASD	Yes	Yes	Easy fatigability, perioral cyanosis	Midline - no deviation or narrowing
7	M	5 months	LAA with aberrant RSA from DA, and left ligamentum arteriosum	6.3	None	Yes	No	Recurrent aspiration, GERD, cyanosis	Midline - no deviation
8	M	21 months	DAA	11.4	None	Yes	Yes	Recurrent RTI requiring multiple hospitalizations, stridor, dysphagia	Midline - significant tracheal narrowing

M: Male; F: Female; DAA: Double aortic arch; RAA: Right aortic arch; LAA: Left aortic arch; LSA: Left subclavian artery; RSA: Right subclavian artery; DA: Descending aorta; ASD: Atrial septal defect; VSD: Ventricular septal defect; PFO: Patent foramen ovale; RTI: Respiratory tract infection; GERD: Gastroesophageal reflux disease; PNA: Pneumonia; ICU: Intensive care unit.

Table 2 Operative and postoperative data of patients with vascular rings

Patient	Surgical technique	Dominant arch (for DAA)	Cardiopulmonary bypass used	Hospital stays (day)	Persistent feeding difficulties	Persistent respiratory symptoms
1	Left posterolateral thoracotomy with division of the ligamentum arteriosum and ligation/division of LAA after delineation of both arches	Right	No	9	No	Yes
2	Median sternotomy with ligation and transection of a long PDA (originating from the aberrant subclavian); banding of main pulmonary artery	Right	Yes	19	No	No
3	Left posterolateral thoracotomy with division of ligamentum arteriosum and ligation/division of abnormal posterior aortic arch	N/A	No	19	No	Yes
4	Median sternotomy with ligation and transection of a long PDA (originating from the aberrant subclavian), and main pulmonary artery banding. Airway was mobilized (trachea/proximal bronchi) after ring release	N/A	No	20	Yes	Yes
5	Left thoracotomy with ligation/transection of the fibrotic PDA followed by transection of the left arch/isthmus (below LSA), with stump management (pleural coverage and posterior fixation of distal stump away from the trachea)	N/A	No	5	No	No
6	Median sternotomy with cardiopulmonary bypass; division/transection of ligamentum arteriosum to relieve the vascular ring, with concomitant ASD closure	Right	Yes	18	No	No
7	Median sternotomy with ligation and transection of the fibrotic PDA to improve exposure and facilitate repair, followed by mobilization, division at origin, and translocation of the aberrant right subclavian artery with end-to-side anastomosis to the right common carotid; the proximal stump was tucked laterally to minimize risk of residual esophageal compression	N/A	No	7	No	No
8	Left posterolateral thoracotomy with transection of the nondominant LAA segment to relieve the vascular ring	Right	Yes	7	No	Yes

DAA: Double aortic arch; LAA: Left aortic arch; ASD: Atrial septal defect; PDA: Patent ductus arteriosus; N/A: Not applicable.