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

Mostafa Elhelali; Mohamed-Adel Elgamal; Ahmed Mostafa; Hysam Abdelmohty; Walid Hassan

doi:doi:10.11648/j.ijcts.20200606.12

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

Mostafa Elhelali, Mohamed-Adel Elgamal, Ahmed Mostafa, Hysam Abdelmohty, Walid Hassan

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 6)

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
Y1 - 2020/12/04
PY - 2020
N1 - https://doi.org/10.11648/j.ijcts.20200606.12
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

Mostafa Elhelali

Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed-Adel Elgamal

Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ahmed Mostafa

Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Hysam Abdelmohty

Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Walid Hassan

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

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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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