Published online April 3, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. e903-e908 (doi:10.1542/peds.2005-1674)
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Right arrow Heart & Blood Vessels

Decade of Experience With Vascular Rings at a Single Institution

Carrie Humphrey, MDa, Kim Duncan, MD, FACSb and Scott Fletcher, MD, FAAP, FACCc

a Department of Pediatrics
c Department of Pediatrics and Radiology, Joint Division of Pediatric Cardiology, Department of Cardiovascular Magnetic Resonance Imaging-Children's Hospital, Creighton University/University of Nebraska Medical Center/Children's Hospital, Omaha, Nebraska
b Department of Surgery, Section of Cardiothoracic Surgery, Nebraska Medical Center, Omaha, Nebraska

OBJECTIVE. Over the past decade, the diagnostic workup of vascular rings has changed at our institution. Despite surgical intervention, we have observed long-term aerodigestive issues in some patients. In an effort to better characterize these pre- and postoperative issues, we reviewed a decade of experience at our institution.

METHODS. We performed a complete chart review of all patients identified as having surgical intervention for vascular ring between January 1993 and December 2003. A questionnaire was mailed to the family of each patient to ascertain a subjective assessment of long-term postoperative issues.

RESULTS. Thirty-eight patients were reviewed and categorized as to specific arch anomaly. Associated cardiac anomalies were present in 29% of patients. Chronic feeding difficulties persisted in 18% of patients, and airway issues remained in nearly half of the patients. Patients with underlying genetic syndromes had less resolution of symptoms compared with nonsyndromic children. Chronic respiratory symptoms were present in 80% of patients operated <6 months, 15% if operated between 6 months and 3 years, and 42% of patients operated after 3 years of age.

CONCLUSIONS. Aerodigestive issues may persist after vascular ring division despite initial improvement. Accurate preoperative anatomic imaging is imperative to surgical planning.

Key Words: vascular ring • imaging • chronic symptoms

Abbreviations: DAA—double aortic arch • RALL—right aortic arch with persistent left ligament • ASA/RDA—aberrant right subclavian artery/left aortic arch with right descending aorta • RA/RLIA—right arch with a retroesophageal left innominate artery • MRA—magnetic resonance angiography • CT—computed tomography

Accepted Nov 4, 2005.