1
|
Shikata F, Shah J, Marathe S, Suna J, Alphonso N, Venugopal P. Upper partial sternal split for pediatric cardiac surgery. Gen Thorac Cardiovasc Surg 2024; 72:505-511. [PMID: 38227106 PMCID: PMC11282121 DOI: 10.1007/s11748-023-01996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES We introduced the use of an upper partial sternal split for pediatric cardiac surgical procedures in our unit in 2016. We report the outcomes of our experience in 51 patients using this approach. METHODS From February 2016 to September 2022, 51 patients underwent congenital cardiac surgical procedures using an upper partial sternal split including vascular ring repair (n = 20), subaortic membrane (n = 12), ventricular septal defect closure with aortic valve resuspension (n = 9), aortic arch repair (n = 4), pulmonary artery band (n = 2), pulmonary artery sling (n = 1), supravalvular aortic stenosis (n = 1), aortic valve replacement (n = 1), and pulmonary artery plasty (n = 1). The surgical approach involved a midline skin incision, based on the manubrium, followed by an upper manubriotomy. No special surgical instrumentation was required. Median patient age was 2.9 years (IQR 1.3, 6.0); median body weight was 15 kg (IQR 9.8, 20). RESULTS There was no mortality and no patient required intraoperative conversion to full sternotomy. One patient required re-exploration for bleeding when the incision was converted to a full sternotomy. There were no wound complications in any patient. Twenty-one patients (41%) were extubated on the table and of the remaining 30 patients, 23 patients (76%) were extubated within 24 h of surgery. Eleven patients did not require intensive care unit (ICU) admission. Median ICU and hospital stay was 1 day (IQR 1, 1.25) and 5 days (IQR 4, 8) ,respectively. CONCLUSION An upper partial sternal split approach is straightforward and can be performed safely with a preferable cosmetic result in selected pediatric cardiac operations.
Collapse
Affiliation(s)
- Fumiaki Shikata
- Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Level 7F, Clinical Directorate, PO Box 3474, South Brisbane, QLD, 4101, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Pediatric Cardiac Research, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Jay Shah
- Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Level 7F, Clinical Directorate, PO Box 3474, South Brisbane, QLD, 4101, Australia
- University of Queensland, Brisbane, QLD, Australia
- Ochsner Medical Center, New Orleans, LA, USA
| | - Supreet Marathe
- Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Level 7F, Clinical Directorate, PO Box 3474, South Brisbane, QLD, 4101, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Pediatric Cardiac Research, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Jessica Suna
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Pediatric Cardiac Research, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Level 7F, Clinical Directorate, PO Box 3474, South Brisbane, QLD, 4101, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia
- Queensland Pediatric Cardiac Research, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Prem Venugopal
- Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Level 7F, Clinical Directorate, PO Box 3474, South Brisbane, QLD, 4101, Australia.
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, QLD, Australia.
- Queensland Pediatric Cardiac Research, Queensland Children's Hospital, South Brisbane, QLD, Australia.
| |
Collapse
|
2
|
McOnie RC, Buote NJ, Hackett ES, Scrivani PV, Mazan MR, Lehmann F, Pomerantz LK, Mitchell KJ. Resolution of chronic regurgitation in an 8 month old Babydoll sheep by thoracoscopic treatment of a vascular ring anomaly. Vet Surg 2024; 53:844-851. [PMID: 38641961 DOI: 10.1111/vsu.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE The objective was to describe the successful thoracoscopic treatment of esophageal entrapment resulting from a vascular ring anomaly (VRA) comprising a persistent right aortic arch (PRAA) and left ligamentum arteriosum (LA) in a Babydoll sheep wether. STUDY DESIGN Case report. ANIMAL Eight month old Babydoll sheep wether, 13 kg. METHODS The patient presented with a weight half that of its sibling, persistent regurgitation following eating, and delayed growth noted from the age of approximately 2 months, coinciding with the introduction of solid feed into the diet. Plain thoracic radiographs were within normal limits but computed tomography angiography (CTA) confirmed multiple congenital vascular anomalies. The primary finding was esophageal and tracheal entrapment by a PRAA and left LA. Thoracoscopic transection of the LA was performed with a bipolar vessel sealing device with the aid of transesophageal endoscopy. RESULTS Immediate improvement in attitude and absence of regurgitation were observed. The patient was discharged and subsequently reintroduced to grazing and long-stem hay, which were previously not tolerated. By 6 months post discharge, the patient's weight was 36 kg, comparable to an age-matched sibling and considered appropriate for the stage of growth. CONCLUSION Thoracoscopic transection of the LA in sheep is a feasible treatment for esophageal compression resulting from a VRA. Surgical intervention resolved the clinical signs and allowed normal digestive rumination, restoring bidirectional esophageal function in a ruminant.
Collapse
Affiliation(s)
- Rebecca C McOnie
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Nicole J Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Eileen S Hackett
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Peter V Scrivani
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Melissa R Mazan
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Fionna Lehmann
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Leah K Pomerantz
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Katharyn J Mitchell
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| |
Collapse
|
3
|
Seth D, Kamat D. All That Wheezes Is Not Asthma. Pediatr Ann 2024; 53:e189-e194. [PMID: 38700922 DOI: 10.3928/19382359-20240306-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Wheezing is a high pitched, whistling sound generated when air flows through narrowed airways and is often equated with asthma. However, wheezing may be a presenting symptom of various other conditions including structural lesions of the airways, foreign body aspiration, pulmonary infections as well as cardiac causes. Underlying etiology of wheezing may also vary with age. Detailed history, physical examination, and laboratory investigations are often required to identify the underlying etiology of wheezing. Additional studies may sometimes be needed to accurately identify the underlying etiology such as pulmonary function test or spirometry, chest radiography (chest X-ray), and bronchoscopy. This review article discusses the common causes of wheezing encountered in clinical practice. [Pediatr Ann. 2024;53(5):e189-e194.].
Collapse
|
4
|
Cockrell HC, Kwon EG, Savochka L, Dellinger MB, Greenberg SLM, Waldhausen JHT. Long-term Outcomes Following Thoracoscopic Division of Vascular Rings. J Pediatr Surg 2024:S0022-3468(24)00240-9. [PMID: 38658219 DOI: 10.1016/j.jpedsurg.2024.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES We evaluate long-term symptomatic improvement in vascular ring patients who underwent thoracoscopic division at a single quaternary pediatric surgery center. METHODS All pediatric patients who underwent vascular ring division without Kommerell's diverticulum resection between 01/2007-12/2022 were included. Surgeries were performed by pediatric general and thoracic surgeons. Patient demographic and clinical characteristics were obtained from retrospective chart review. Data on long-term symptomatic improvement were collected with structured telephone interviews. RESULTS 60% of patients were male. Median age at operation was 24 months (IQR: 11, 60 months) with a median weight of 11.3 kg (IQR: 8.7, 19.8 kg). All patients were symptomatic preoperatively with dysphagia being the most frequent complaint (42%), followed by chronic cough (21%). Of 41 patients eligible for the long-term follow-up survey, 8 patients with a primary diagnosis of a double arch with an atretic segment in the non-dominant arch and 9 with a right dominant arch with left ligamentum arteriosum and aberrant left subclavian artery (LSCA) were contacted and consented for participation. Median interval from surgery to survey completion was 95 months (IQR 28, 135 months). Most patients had no, or only minor, symptoms related to breathing and swallowing at the time of long-term follow-up. 88% of patients experienced postoperative symptom improvement, and only one patient reported worsening of symptoms over time. CONCLUSION Division of an atretic arch and/or ligamentum for patients with an aberrant LSCA without Kommerell's resection may be adequate to ensure long-term improvement of breathing and swallowing problems attributable to vascular rings. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Eustina G Kwon
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Liya Savochka
- University of Washington School of Medicine, 1959 NE Pacific Street, A-300 Health Sciences Center, Box 356340, Seattle, WA 98195, USA
| | - Matthew B Dellinger
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sarah L M Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - John H T Waldhausen
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| |
Collapse
|
5
|
Wadle M, Joffe D, Backer C, Ross F. Perioperative and Anesthetic Considerations in Vascular Rings and Slings. Semin Cardiothorac Vasc Anesth 2024:10892532241234404. [PMID: 38379198 DOI: 10.1177/10892532241234404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.
Collapse
Affiliation(s)
| | | | - Carl Backer
- Kentucky Children's Hospital Congenital Heart Clinic, Lexington, KY, USA
| | - Faith Ross
- Seattle Children's Hospital, Seattle, WA, USA
| |
Collapse
|
6
|
Long term respiratory morbidity in patients with vascular rings: a review. Ital J Pediatr 2023; 49:24. [PMID: 36797770 PMCID: PMC9936697 DOI: 10.1186/s13052-023-01430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
Abnormalities in position and/or branching of the aortic arch can lead to vascular rings that may cause narrowing of the tracheal lumen due to external compression, or constriction of the oesophagus, causing symptoms that vary in relation to the anatomical vascular pattern and the relationship between these structures. Respiratory morbidity related to external airways compression is a major concern in children affected by vascular rings. Clinical presentation depends on the severity of the tracheal lumen reduction and the presence of associated tracheomalacia. Recurrent respiratory infections, wheezing, atelectasis, and hyperinflation are mostly reported. As they are nonspecific and therefore difficult to recognize, attention should be given to all children with history of respiratory distress, extubation failure, noisy breathing, and recurrent respiratory infections. Early diagnosis and referral to specialized centres can prevent the long-term complications and improve the respiratory outcomes of these patients.
Collapse
|
7
|
Abstract
Vascular rings are congenital aortic arch anomalies that lead to compression of the trachea or esophagus. The goal of this review is to summarize our current recommendations for the management of patients with a diagnosis of a vascular ring. We review the history, classification methods, and epidemiology of the various types of vascular rings. We then propose a management strategy for the relatively new paradigm of fetal diagnosis, including the management of asymptomatic vascular rings. Finally, we finish with a review of the operative techniques and outcomes for the four main categories of vascular rings.
Collapse
|
8
|
Amir G, Soffair N, Bruckheimer E, Nachum E, Shoenfeld T, Rotstein A, Frenkel G, Birk E. Mid-term results of vascular ring surgery. Cardiol Young 2021; 32:1-6. [PMID: 34776035 DOI: 10.1017/s1047951121004224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Vascular rings cause respiratory symptoms in children. Treatment consists of surgical division; however, data regarding mid-term results are scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. METHODS Retrospective chart review of consecutive patients who underwent vascular ring surgery. Mid-term follow-up consisted of clinic visits and telephone questionnaire over a 1-year period sampling at five points in time. RESULTS Follow-up of 85 patients who underwent vascular rings surgery revealed significant symptomatic improvement within 6 months. In total, 50% were symptomatic to some degree at their last documented clinic visit complaining of stridor (36.8%), cough (34.2%), wheezing (10.5%), dyspnoea on exertion (10.5%), or recurrent respiratory infections (23.7%). By telephone questionnaires, 83% described a significant improvement in respiratory symptoms, 63.4% had some residual symptoms, 36.6% stridor, 38.8% chronic cough, 32.4% bronchodilator use,18.3% had at least one episode of pneumonia per year, 31% of children had dyspnoea or respiratory limitation, and 12.7% while doing physical activities. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. CONCLUSIONS Surgical division of vascular rings results in significant clinical improvement within 1 year; nevertheless, some patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. Further evaluation is warranted to assess the nature of residual symptoms and explore whether anatomical causes can be identified leading to surgical modifications.
Collapse
Affiliation(s)
- Gabriel Amir
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Niv Soffair
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Elchanan Nachum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Tommy Shoenfeld
- Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amichai Rotstein
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Einat Birk
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| |
Collapse
|
9
|
Ding N, Guo J, Li X, Cao Y, Yi H, Li Z. Kommerell diverticulum, vascular ring, and aberrant left subclavian artery: LSCA translocation or aortopexy. J Pediatr Surg 2021; 56:1757-1763. [PMID: 33678405 DOI: 10.1016/j.jpedsurg.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/16/2020] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE Kommerell diverticulum (KD) in children with right aortic arch and aberrant left subclavian artery can be treated surgically via left subclavian artery (LSCA) translocation or aortopexy. These procedures remain controversial. We compared the outcomes of both procedures. METHODS This retrospective study included 48 patients who underwent LSCA translocation (n = 26) or aortopexy (n = 22). Lateral thoracotomy and sternotomy were performed in 38 and 10 patients with severe intracardiac malformations, respectively. RESULTS The median age of the aortopexy group was 10 months, median follow-up was 14 months, and mean length of hospitalization was 11.41 ± 6.8 days. The median age of the LSCA translocation group was 12 months, median follow-up was 22 months, and mean length of hospitalization was 14.96 ± 7.74 days. Two patients (LSCA translocation group) required secondary intubations and none suffered from recurrent laryngeal nerve injury or complications related to LSCA translocation. Breathing and swallowing symptoms were relieved in all patients. No additional thoracotomies due to respiratory symptoms were required. CONCLUSIONS These two procedures relieve the pressure on the trachea and esophagus with similar short-term outcomes. The long-term outcomes are unknown. LSCA translocation may be the best strategy to prevent symptom recurrence and late complications in these patients. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Nan Ding
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jian Guo
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaofeng Li
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yongli Cao
- Department of Imaging Centre, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hanlu Yi
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhiqiang Li
- Department of Cardiovascular Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
| |
Collapse
|
10
|
Vigneswaran TV, Van Poppel MP, Griffiths B, James P, Jogeesvaran H, Rahim Z, Simpson JM, Speggiorin S, Zidere V, Nyman A. Postnatal impact of a prenatally diagnosed double aortic arch. Arch Dis Child 2021; 106:564-569. [PMID: 33115711 DOI: 10.1136/archdischild-2020-318946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND A double aortic arch (DAA) is increasingly identified before birth; however, there are no published data describing the postnatal outcome of a large prenatal cohort. OBJECTIVE To describe the associations, symptoms and impact of prenatally diagnosed DAA. METHODS Retrospective review of consecutive cases seen at two fetal cardiology units from 2014 to 2019. Clinical records including symptoms and assessment of tracheobronchial compression using flexible bronchoscopy were reviewed. Moderate-severe tracheal compression was defined as >75% occlusion of the lumen. RESULTS There were 50 cases identified prenatally and 48 with postnatal follow-up. Array comparative genomic hybridisation (aCGH) was abnormal in 2/50 (4%), aCGH was normal in 33/50 (66%) and of those reviewed after birth, 13 were phenotypically normal. After birth, there was a complete DAA with patency of both arches in 8/48 (17%) and in 40/48 (83%) there was a segment of the left arch which was a non-patent, ligamentous connection.Stridor was present in 6/48 (13%) on the day of birth. Tracheo-oesophageal compressive symptoms/signs were present in 31/48 (65%) patients at median age of 59 days (IQR 9-182 days). Tracheal/carinal compression was present in 40/45 (88%) cases. Seven of 17 (41%) asymptomatic cases demonstrated moderate-severe tracheal compression. All morphologies of DAA caused symptoms and morphology type was not predictive of significant tracheal compression (p=0.3). CONCLUSIONS Genetic testing should be offered following detection of double aortic arch. Early signs of tracheal compression are common and therefore delivery where onsite neonatal support is available is recommended. Significant tracheal compression may be present even in the absence of symptoms.
Collapse
Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK .,Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Milou Pm Van Poppel
- Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benedict Griffiths
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Paul James
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Haran Jogeesvaran
- Department of Radiology, Evelina London Children's Hospital, London, UK
| | - Zehan Rahim
- Paediatric Respiratory Medicine, Evelina London Children's Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.,Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Simone Speggiorin
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.,Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| |
Collapse
|
11
|
Biermann D, Holst T, Hüners I, Rickers C, Kehl T, Rüffer A, Sachweh JS, Hazekamp MG. Right aortic arch forming a true vascular ring: a clinical review. Eur J Cardiothorac Surg 2021; 60:1014-1021. [PMID: 33970211 DOI: 10.1093/ejcts/ezab225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/02/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This review aims at presenting and summarizing the current state of literature on the presentation and surgical management of a right-sided aortic arch with a left-sided ligamentum forming a complete vascular ring around the oesophagus and trachea. METHODS A systematic database search for appropriate literature was conducted on PubMed/MEDLINE. Articles were considered relevant when providing details on the presentation, diagnosis and surgical treatment of this specific congenital arch anomaly in human beings. RESULTS Affected patients present with respiratory and/or oesophageal difficulties due to tracheoesophageal compression. Conservative treatment might be reasonable in asymptomatic or mildly symptomatic cases; however, once moderate-to-severe symptoms develop, surgical intervention is definitely indicated. Surgery is commonly performed through a left thoracotomy or median sternotomy and includes the division of the left ductal ligamentum; if a Kommerell's diverticulum is present that is >1.5 times the diameter of the subclavian artery, then concomitant resection of the large diverticulum and translocation of the aberrant left subclavian artery is also conducted. Postoperative morbidity and mortality are low and are rather related to concomitant intracardiac and extracardiac anomalies than to the procedure itself. In a majority of patients, full resolution of symptoms is seen within months to years from the surgery. Nevertheless, there is also a subset of patients who remain with some tracheobronchial narrowing, sometimes even requiring reintervention during follow-up due to persisting or recurring symptoms. CONCLUSIONS Overall, the surgical management of a right aortic arch forming a true vascular ring in infancy, childhood and adulthood seems relatively safe and effective in providing symptomatic relief despite some persistent tracheobronchial and/or oesophageal narrowing in some cases.
Collapse
Affiliation(s)
- Daniel Biermann
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.,Surgery for Congenital Heart Disease, University Heart and Vascular Center, Hamburg, Germany
| | - Theresa Holst
- Surgery for Congenital Heart Disease, University Heart and Vascular Center, Hamburg, Germany
| | - Ida Hüners
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.,Surgery for Congenital Heart Disease, University Heart and Vascular Center, Hamburg, Germany
| | - Carsten Rickers
- Adult Congenital Heart Disease Section, University Heart and Vascular Center, Hamburg, Germany
| | - Torben Kehl
- Department of Pediatric Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - André Rüffer
- Surgery for Congenital Heart Disease, University Heart and Vascular Center, Hamburg, Germany
| | - Jörg S Sachweh
- Surgery for Congenital Heart Disease, University Heart and Vascular Center, Hamburg, Germany
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
12
|
Haranal M, Srimurugan B, Sivalingam S. Circumflex aorta: An uncharted territory. Asian Cardiovasc Thorac Ann 2021; 30:217-225. [PMID: 33957784 DOI: 10.1177/02184923211015092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vascular rings are aortic arch anomalies with a spectrum of manifestations ranging from asymptomatic lesions detected incidentally to an acute presentation secondary to tracheo-esophageal compression. Circumflex retro-esophageal aortic arch is an extreme form of true vascular ring. It remains an uncharted territory to many surgeons. METHODS A comprehensive search of peer reviewed journals was completed based on the key words, "Circumflex aorta," "Circumflex retro-esophageal aorta" and "circumflex arch" using Google scholar, Scholars Portal Journals and PubMed. The reference section for each article found was searched to obtain additional articles. Literature on the circumflex aorta was reviewed starting from the embryogenesis to the latest management strategies. RESULTS Right circumflex aorta is more prevalent compared to left circumflex aorta. It can occur in isolation or in association with other intracardiac lesions. Mainly presents in children, however reported in adults too. The presentation may vary from asymptomatic lesion to acute respiratory distress secondary to airway compression. Computerized tomography (CT) and magnetic resonance imaging (MRI) are important tools in delineating the vascular anatomy. Aortic uncrossing is the definitive procedure. However, the role of concomitant tracheobronchopexy is emerging. Native tissue-to-tissue anastomosis is commonly preferred, but cases of extra-anatomic grafts are reported. CONCLUSION Circumflex aorta is amenable to complete repair. Preoperative delineation of anatomy is important for successful surgical outcome. Division of the retro-esophageal segment is crucial in relieving the compressive symptoms. In addition, tracheobronchopexy is helpful in addressing residual tracheomalacia but this accounts for a high-risk surgery.
Collapse
Affiliation(s)
- Maruti Haranal
- Department of Cardiac Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Balaji Srimurugan
- Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | | |
Collapse
|
13
|
Regier PJ, Case JB, Fox-Alvarez WA. Ligation of the ligamentum arteriosum and aberrant left subclavian artery in five dogs in which persistent right aortic arch had been diagnosed. Vet Surg 2021; 50 Suppl 1:O26-O31. [PMID: 33503311 DOI: 10.1111/vsu.13575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/05/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine and report the diagnosis, treatment, and outcome in dogs with persistent right aortic arch (PRAA) with an aberrant left subclavian artery (ALS) that underwent thoracoscopic surgery. ANIMALS Dogs with PRAA and an ALS (n = 5). STUDY DESIGN Short case series. METHODS Medical records were reviewed from 2014 to 2019. Dogs that underwent thoracoscopy for PRAA with an ALS at an academic referral hospital were included. Signalment, clinical signs, diagnostic imaging, surgical approach, complications, and short- and long-term outcomes were recorded. RESULTS Persistent right aortic arch with an ALS was identified in five dogs. Dogs initially underwent a three-port intercostal thoracoscopic approach, and an intercostal thoracotomy was performed in converted cases. In all five dogs, the ligamentum arteriosum (LA) and ALS were divided; three were performed by a thoracoscopy alone. Two cases were converted because of poor exposure (1) and requirement to temporary occlude an ALS (1). The ALS was ligated and divided in all dogs without apparent negative effects. No intraoperative or postoperative complications occurred. Four dogs had resolution of regurgitation, three of which required diet modification. One dog had reported regurgitation when it was excited. Median follow-up was 188 days (range, 150-1133). CONCLUSION Ligation and division of both the LA and the ALS in all dogs in this case series was safe and allowed for improvement in clinical signs and good to excellent long-term outcomes. In addition, both thoracoscopy and thoracotomy were used safely and successfully for ligation and transection of the LA and ALS in all dogs.
Collapse
Affiliation(s)
- Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - W Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
14
|
Alsarraj MK, Nellis JR, Vekstein AM, Andersen ND, Turek JW. Borrowing from Adult Cardiac Surgeons-Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 15:101-105. [PMID: 32352905 DOI: 10.1177/1556984520911020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.
Collapse
Affiliation(s)
- Mohammed K Alsarraj
- 367854 Central Michigan University College of Medicine, Mount Pleasant, MI, USA.,22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Joseph R Nellis
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA
| | - Andrew M Vekstein
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
| | - Nicholas D Andersen
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
| | - Joseph W Turek
- 22957 Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA.,22957 Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
| |
Collapse
|
15
|
Callahan CP, Merritt TC, Canter MW, Eghtesady P, Manning PB, Abarbanell AM. Symptom persistence after vascular ring repair in children. J Pediatr Surg 2020; 55:2317-2321. [PMID: 32005503 DOI: 10.1016/j.jpedsurg.2019.12.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/18/2019] [Accepted: 12/26/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Vascular rings are often diagnosed after evaluation for swallowing and breathing difficulties. Data regarding symptoms following vascular ring repair is sparse. We sought to determine whether symptoms persist using chart review and a survey. METHODS Sixty-three patients underwent open vascular ring repair from July 2007 to May 2018. Data regarding vascular anatomy, demographics, pre- and postoperative symptoms, and chromosomal abnormalities were collected. Freedom from reoperation, 30-day mortality, and complications were assessed. Patient families were contacted for a symptom focused survey. RESULTS The median age of surgical intervention was 14.4 months (IQR 5.8-34.7 months) for single aortic arches with an aberrant subclavian artery (SAA), and 5.3 months (IQR 1.3-10.1 months) for double aortic arches (DAA) (Table). Prior to surgery, all but two SAA were symptomatic. There was no operative mortality. Three patients required re-exploration for chylothorax, and three required late aortopexy. At last follow-up, 45% (18/40) SAA and 65% (15/23) DAA had post-operative symptoms. Fourteen patient families completed the symptom survey (10 SAA, 4 DAA). Five SAA had breathing and swallowing symptoms, and 3 SAA and 3 DAA had breathing difficulties. CONCLUSIONS Open vascular ring repair remains a safe repair. However, further investigation of the persistent symptoms in these patients is merited. STUDY TYPE / LEVEL OF EVIDENCE Retrospective Comparative Study, Level III.
Collapse
Affiliation(s)
- Connor P Callahan
- Washington University School of Medicine, Department of Surgery, 660 S. Euclid, Campus Box 8109, St. Louis, MO 63110.
| | - Taylor C Merritt
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine; One Children's Place, Campus Box 8234, St. Louis, MO 63110
| | - Matthew W Canter
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine; One Children's Place, Campus Box 8234, St. Louis, MO 63110
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine; One Children's Place, Campus Box 8234, St. Louis, MO 63110
| | - Peter B Manning
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine; One Children's Place, Campus Box 8234, St. Louis, MO 63110
| | - Aaron M Abarbanell
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine; One Children's Place, Campus Box 8234, St. Louis, MO 63110
| |
Collapse
|
16
|
Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus. Cardiol Young 2020; 30:1433-1438. [PMID: 32753077 DOI: 10.1017/s1047951120002206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patent ductus arteriosus closure is traditionally performed by thoracotomy approach. Video-assisted thoracoscopic surgery is a less frequently utilised alternative. We sought to compare elective surgical outcomes between the two methods via a single-centre retrospective cohort analysis. METHODS All patients >3.2 kg undergoing surgical patent ductus arteriosus ligation at a single institution from 2000 to 2018 were retrospectively reviewed. Propensity matching for age, weight, diuretic usage, and preterm status was conducted to adjust for differences in baseline patient characteristics. Outcome measures included operative time, hospitalisation duration, post-operative complications, and re-operation. RESULTS A total of 173 patients were included, 127 thoracoscopy and 46 thoracotomy. In the unmatched cohorts, no significant difference in closure success was found (94% thoracoscopy versus 100% thoracotomy, p = 0.192). Although median operative time was longer for thoracoscopy (87 versus 56 minutes, p < 0.001), hospitalisation duration was shorter (1.05 versus 2.41 days, p < 0.001), as was ICU stay (0.00 versus 0.75 days, p < 0.001). There were no significant differences in re-operation or complication rates, except chest tube placement (11% thoracoscopy versus 50% thoracotomy, p < 0.001). After matching (69 thoracoscopy versus 20 thoracotomy), these differences persisted, including median operative time (81 versus 56 minutes, p = 0.007; thoracoscopy versus thoracotomy), hospitalisation duration (1.25 versus 2.27 days, p < 0.001), and chest tube placement (17% versus 60%, p < 0.001). There remained no significant difference in complications or re-operations. CONCLUSIONS Thoracoscopic ligation was associated with shorter ICU and hospital stays and less frequent chest tube placement, but longer operative times. Other risks, including bleeding, chylothorax, and recurrent laryngeal nerve injury, were similar.
Collapse
|
17
|
Kamran A, Friedman KG, Jennings RW, Baird CW. Aortic uncrossing and tracheobronchopexy corrects tracheal compression and tracheobronchomalacia associated with circumflex aortic arch. J Thorac Cardiovasc Surg 2020; 160:796-804. [DOI: 10.1016/j.jtcvs.2020.03.158] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 02/26/2020] [Accepted: 03/07/2020] [Indexed: 11/17/2022]
|
18
|
Ghincea CV, Ikeno Y, Weyant MJ, Mitchell JD, Aftab M, Reece TB. Right Thoracoscopic Aberrant Right Subclavian Artery Division and Subclavian-Carotid Transposition. Ann Thorac Surg 2020; 110:e431-e433. [PMID: 32407854 DOI: 10.1016/j.athoracsur.2020.03.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
Video-assisted thoracoscopic surgical division of obstructive congenital vascular rings has been demonstrated to be a safe technique in the setting of right-sided or double aortic arch, requiring a left-sided thoracic approach. This report describes 2 cases of aberrant right subclavian artery division using right video-assisted thoracoscopic surgery and subclavian-carotid transposition. This approach is safe and feasible in the management of symptomatic aberrant right subclavian artery without the morbidity of a thoracotomy incision, although patients require ongoing surveillance.
Collapse
Affiliation(s)
- Christian V Ghincea
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Yuki Ikeno
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael J Weyant
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado.
| |
Collapse
|
19
|
Abstract
A vascular ring is a rare congenital cardiovascular anomaly, which encircles and compresses the trachea or esophagus, or both. In this review we discuss the pathophysiology, theoretical embryopathogenesis, diagnostic modalities, and surgical treatment of the different types of vascular ring. Knowledge of the normal embryonic development of the aortic arch and related structures is important for understanding and classifying the various forms of vascular ring. The development of a vascular ring begins with the embryonic aortic arch system. The persistence, involution, or regression of the arches determines the multiple variations of vascular ring. With the development of new technologies, multi-detector computed tomography (MDCT) has become a good diagnostic modality for pre- and postoperative evaluation. MDCT provides an excellent image of aortic arch abnormalities and the related anatomy, as well as the tracheal pathology. For patients with symptoms, surgical division of the vascular ring usually achieves excellent outcomes with marked resolution of symptoms and a low risk of morbidity and mortality. Symptomatic vascular rings require early surgical intervention to prevent prolonged vascular compression of the airway and serious complications.
Collapse
|
20
|
Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
Collapse
Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
| |
Collapse
|
21
|
Vigneswaran TV, Kapravelou E, Bell AJ, Nyman A, Pushparajah K, Simpson JM, Durward A, Zidere V. Correlation of Symptoms with Bronchoscopic Findings in Children with a Prenatal Diagnosis of a Right Aortic Arch and Left Arterial Duct. Pediatr Cardiol 2018; 39:665-673. [PMID: 29307026 DOI: 10.1007/s00246-017-1804-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/22/2017] [Indexed: 12/31/2022]
Abstract
A right aortic arch (RAA) with a left arterial duct (LAD) together encircle the trachea and have the potential to cause tracheobronchial compression and published guidelines recommend bronchoscopy in symptomatic patients. The aim of the study was to describe the incidence of tracheal compression in a cohort of prenatally diagnosed RAA and LAD. Retrospective review of clinical course and imaging of prenatal cases of RAA and LAD assessed with flexible bronchoscopy over an 11-year period. 34 cases of prenatally diagnosed RAA with LAD underwent bronchoscopy at median age of 9 months (range 0.4-123) of whom 11 had respiratory symptoms and 23 were asymptomatic. In the neonatal period, three cases demonstrated respiratory symptoms. An aberrant left subclavian artery (ALSA) was identified in 29 cases. Pulsatile tracheal compression was identified in 32/34 (94%) cases and two cases showed normal tracheal appearances. Significant tracheal compression (> 70% occlusion) was present in 25/34 (74%) cases of which 16 were asymptomatic. Significant carinal compression (> 70% occlusion) was identified in 14/34 (42%) cases, an ALSA was observed in 13/14. Surgical relief of a vascular ring has been performed in 27 (79%) cases at a median age of 15 months (range 0.6-128 months). At surgery, a fibrous remnant of an atretic left aortic arch was identified in 11/27 (41%) cases. Significant tracheal compression may be present in infants even without symptoms. If early relief of airway compression is to be achieved to promote normal development of tracheal cartilage, early bronchoscopy should be considered.
Collapse
Affiliation(s)
- Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK. .,Fetal Medicine Research Institute, King's College Hospital, 16-20 Windsor Walk, London, SE5 8BB, UK.
| | - Eva Kapravelou
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Aaron J Bell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Andrew Nyman
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Kuberan Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK.,Fetal Medicine Research Institute, King's College Hospital, 16-20 Windsor Walk, London, SE5 8BB, UK
| | - Andrew Durward
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, SE1 7EH, UK.,Fetal Medicine Research Institute, King's College Hospital, 16-20 Windsor Walk, London, SE5 8BB, UK
| |
Collapse
|
22
|
Backer CL, Rigsby CK. Vascular rings: To scope or not to scope. J Thorac Cardiovasc Surg 2017; 154:616-617. [PMID: 28412114 DOI: 10.1016/j.jtcvs.2017.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Cynthia K Rigsby
- Division of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| |
Collapse
|