Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-28T21:40:29.848Z Has data issue: false hasContentIssue false

Chapter 44 - Vascular Ring

from Section 7 - Miscellaneous Lesions and Syndromes

Published online by Cambridge University Press:  09 September 2021

By
Katherine L. Zaleski
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
Get access

Summary

A vascular ring is a congenital malformation of the aorta and its branch vessels in which the esophagus and/or tracheobronchial tree are either completely (complete ring) or partially (incomplete ring) encircled by vascular structures and/or their atretic remnants, resulting in mechanical obstruction of these structures and resultant symptomatology. Vascular rings result from abnormal segmental regression and/or persistence of portions of the embryonic aortic arch complex. Infants may present with recurrent upper respiratory infections or pneumonia, wheezing, stridor, slow feeding, gastroesophageal reflux or vomiting, and/or failure to thrive. In children and older patients, the symptoms are similar to those seen in infancy with the addition of dysphagia to solids. Surgical division of a vascular ring is indicated when symptoms of airway and/or esophageal compression are present and is generally performed without delay once a diagnosis is made. This chapter highlights the perioperative anesthetic challenges in caring for a child for airway evaluation of a suspected vascular ring.

Keywords

double aortic archvascular ring
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 338 - 344
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References

Gross, R. E.. Surgical relief for tracheal obstruction from a vascular ring. N Engl J Med 1945; 233: 586–90.CrossRefGoogle ScholarPubMed
Backer, C. L. and Mavroudis, C.. Vascular rings and pulmonary artery sling. In Mavroudis, C., Backer, C. L. eds. Pediatric Cardiac Surgery, 4th ed. Oxford: Wiley-Blackwell, 2013; 234–55.Google Scholar
Evans, W. N., Acherman, R. J., Ciccolo, M. L., et al. Vascular ring diagnosis and management: notable trends over 25 years. World J Pediatr Congenit Heart Surg 2016; 7: 717–20.CrossRefGoogle ScholarPubMed
Lowe, G. M., Donaldson, J. S., and Backer, C. L.. Vascular rings: 10-year review of imaging. Radiographics 1991; 11: 637–46.CrossRefGoogle ScholarPubMed
Kocis, K. C., Midgley, F. M., and Ruckman, R. N.. Aortic arch complex anomalies: 20-year experience with symptoms, diagnosis, associated cardiac defects, and surgical repair. Pediatr Cardiol 1997; 18: 127–32.CrossRefGoogle ScholarPubMed
Naimo, P. S., Fricke, T. A., Donald, J. S., et al. Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution. Interact Cardiovasc Thorac Surg 2017; 24: 234–9.Google ScholarPubMed
Backer, C. L. and Mavroudis, C.. Congenital Heart Surgery Nomenclature and Database Project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg 2000; 69: S298–307.CrossRefGoogle ScholarPubMed
Schleich, J. M.. Images in cardiology: development of the human heart – days 15–21. Heart 2002; 87: 487.CrossRefGoogle ScholarPubMed
Kussman, B. D., Geva, T., and McGowan, F. X.. Cardiovascular causes of airway compression. Paediatr Anaesth 2004; 14: 60–74.CrossRefGoogle ScholarPubMed
Hanneman, K., Newman, B., and Chan, F.. Congenital variants and anomalies of the aortic arch. Radiographics 2017; 37: 32–51.CrossRefGoogle ScholarPubMed
Shah, R. K., Mora, B. N., Bacha, E., et al. The presentation and management of vascular rings: an otolaryngology perspective. Int J Pediatr Otorhinolaryngol 2007; 71: 57–62.CrossRefGoogle ScholarPubMed
Loomba, R. S.. Natural history of asymptomatic and unrepaired vascular rings: is watchful waiting a viable option? A new case and review of previously reported cases. Children 2016; 3: 44.Google Scholar
Berdon, W. E., Baker, D. H., Wung, J. T., et al. Complete cartilage-ring tracheal stenosis associated with anomalous left pulmonary artery: the ring-sling complex. Radiology 1984; 152: 57–64.CrossRefGoogle ScholarPubMed
Nguyen, L. T., Fleishman, R., Flynn, E., et al. 22q11.2 microduplication syndrome with associated esophageal atresia/tracheo-esophageal fistula and vascular ring. Clin Case Rep 2017; 5: 351–6.CrossRefGoogle ScholarPubMed
Bonnard, A., Auber, F., Fourcade, L., et al. Vascular ring abnormalities: a retrospective study of 62 cases. J Pediatr Surg 2003; 38: 539–43.CrossRefGoogle ScholarPubMed
Etesami, M., Ashwath, R., Kanne, J., et al. Computed tomography in the evaluation of vascular rings and slings. Insights Imaging 2014; 5: 507–21.CrossRefGoogle ScholarPubMed
Kogon, B. E., Forbess, J. M., Wulkan, M. L., et al. Video-assisted thoracoscopic surgery: is it a superior technique for the division of vascular rings in children? Congenit Heart Dis 2007; 2: 130–3.CrossRefGoogle ScholarPubMed
Luciano, D., Mitchell, J., Fraisse, A., et al. Kommerell diverticulum should be removed in children with vascular ring and aberrant left subclavian artery. Ann Thorac Surg 2015; 100: 2293–7.CrossRefGoogle ScholarPubMed
Robbertze, R., Posner, K. L., and Domino, K. B.. Closed claims review of anesthesia for procedures outside the operating room. Curr Opin Anaesthesiol 2006; 19: 436–42.CrossRefGoogle ScholarPubMed
Cravero, J. P., Beach, M. L., Blike, G. T., et al. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 2009; 108: 795–804.CrossRefGoogle ScholarPubMed
Grunwell, J. R., Travers, C., McCracken, C. E., et al. Procedural sedation outside of the operating room using ketamine in 22,645 children: a report from the Pediatric Sedation Research Consortium. Pediatr Crit Care Med 2016; 17: 1109–16.CrossRefGoogle Scholar
Lawlor, C., Smithers, C. J., Hamilton, T., et al. Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy. Laryngoscope 2019; 130: E65–74.Google ScholarPubMed

Suggested Reading

Backer, C. L., Mavroudis, C., Rigsby, C. K., et al. Trends in vascular ring surgery. J Thorac Cardiovasc Surg 2005; 129: 1339–47.CrossRefGoogle ScholarPubMed
Backer, C. L., Mongé, M. C., Popescu, A. R., et al. Vascular rings. Semin Pediatr Surg 2016; 25: 165–75.CrossRefGoogle ScholarPubMed
Hanneman, K., Newman, B., and Chan, F. Congenital variants and anomalies of the aortic arch. Radiographics 2017; 37: 32–51.CrossRefGoogle ScholarPubMed
Herrin, M. A., Zurakowski, D., Fynn-Thompson, F., et al. Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults. J Thorac Cardiovasc Surg 2017; 154: 607–15.CrossRefGoogle ScholarPubMed
Kussman, B. D., Geva, T., and McGowan, F. X. Cardiovascular causes of airway compression. Paediatr Anaesth 2004; 14: 60–74.CrossRefGoogle ScholarPubMed
Priya, S., Thomas, R., Nagpal, P., et al. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther 2018; 8: S26–44.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×