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Bennett S, Hornberger LK, Fruitman D, Bradley TJ, Mansukhani GP. Fetal diagnosis and management of pulmonary artery sling: A case series. Prenat Diagn 2024; 44:868-875. [PMID: 38446572 DOI: 10.1002/pd.6540] [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: 12/21/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Pulmonary artery sling is a rare congenital anomaly accounting for 2% of all patients with vascular anomalies that cause airway obstruction. In the normal heart, the left (LPA) and right (RPA) pulmonary arteries arise in the intrapericardial space. However, in the pulmonary artery sling, the LPA trunk arises in the extrapericardial space from the posterior aspect of the mid RPA and courses posterior to the trachea causing tracheal compression and, at times, bronchial compression. While a full spectrum of congenital cardiac pathology can be identified before birth, only a few case reports document the prenatal diagnosis of an Left pulmonary artery sling (LPAS). METHOD We retrospectively identified all cases of prenatal LPAS from three Canadian fetal cardiology centers (2015-2022). RESULTS Using the 3-vessel-tracheal view via fetal echocardiography (FE), four fetuses from three pregnancies demonstrated abnormal origin of the LPA from RPA and echogenic trachea. In one of two affected monochorionic twins coronal imaging demonstrated a significant narrowing of the large airways consistent with significant airway obstruction. CONCLUSION Prenatal detection of LPAS by FE is possible and should prompt an evaluation for airway obstruction in the coronal view. Investigating associated lesions and genetic testing are recommended for informed shared decision making.
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Affiliation(s)
- Scott Bennett
- Fetal & Neonatal Cardiology, Division of Cardiology, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology, Division of Cardiology, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Deborah Fruitman
- Division of Cardiology, Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Timothy J Bradley
- Division of Cardiology, Department of Pediatrics, University of Saskatchewan and Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - Gitanjali P Mansukhani
- Division of Cardiology, Department of Pediatrics, University of Western Ontario and London Health Science Centre, London, Ontario, Canada
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2
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Farje D, Young A, Stein E, Eltayeb OM, Ghadersohi S, Hazkani I. Persistence of aerodigestive symptoms after vascular ring repair. Am J Otolaryngol 2024; 45:104147. [PMID: 38101126 DOI: 10.1016/j.amjoto.2023.104147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Vascular rings are often associated with respiratory and swallowing difficulties due to tracheal or esophageal compression. While the results of a vascular ring repair are considered excellent, the long-term effect of tracheal and esophageal remodeling and the persistence of symptoms have scarcely been reported. Our study aims to evaluate the respiratory and swallowing outcomes of vascular ring repair. STUDY DESIGN AND METHODS A retrospective cohort study of children who underwent vascular ring repair between 2010 and 2022 in a tertiary-care children's hospital. RESULTS There were 108 patients enrolled: sixty-three patients (57.41 %) with a right aortic arch, 42 patients (38.89 %) with a double aortic arch, and 3 patients (2.78 %) with other vascular rings. Forty-three (39.81 %) patients were diagnosed prenatally. Of the 65 patients (60.19 %) diagnosed postnatally, 35/65 (53.85 %) had either respiratory or swallowing symptoms as the indication for diagnostic workup. Persistent respiratory and swallowing symptoms were noted in 34/108 (31.48 %) and 30/108 (27.78 %) patients, respectively, within a year of surgical repair. Fourteen patients underwent repeated laryngoscopy and bronchoscopy that demonstrated residual tracheomalacia; however, only 2/14 (1.9 %) patients required tracheostomy tube placement, and 6-out-of-7 patients were weaned off positive pressure airway support. Persistent respiratory symptoms were significantly more common in patients with a double aortic arch compared to a right aortic arch. No differences were noted in demographics, comorbidities, and preoperative aerodigestive symptoms between patients with residual symptoms and patients with no residual symptoms. CONCLUSIONS Persistent respiratory and swallowing symptoms after vascular ring repair are not uncommon. Postoperative evaluation should be pursued by a dedicated team, and treatment considered as appropriate.
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Affiliation(s)
- Doris Farje
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ashley Young
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eli Stein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Osama M Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, IL 60611, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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3
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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.
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Affiliation(s)
| | | | - Carl Backer
- Kentucky Children's Hospital Congenital Heart Clinic, Lexington, KY, USA
| | - Faith Ross
- Seattle Children's Hospital, Seattle, WA, USA
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4
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Petreschi F, Coretti A, Porcaro F, Toscano A, Campanale CM, Trozzi M, Secinaro A, Allegorico A, Cutrera R, Carotti A. Pediatric airway compression in aortic arch malformations: a multidisciplinary approach. Front Pediatr 2023; 11:1227819. [PMID: 37547103 PMCID: PMC10401269 DOI: 10.3389/fped.2023.1227819] [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: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Aortic arch malformations (AAMs) should be suspected in the presence of persistent respiratory symptoms despite medical treatment or feeding problems at the pediatric age. Aim We report a descriptive cohort of patients with AAMs and the local management protocol applied. Methods A total of 59 patients with AAM were retrospectively reviewed. Three groups were identified: double aortic arch (DAA), group 1; complete vascular ring (non-DAA), group 2; and anomalous origin of the innominate artery (IA), group 3. Results Prenatal diagnosis was available for 62.7% of the patients. In all, 49.2% of children were symptomatic. There was a significantly different prevalence of respiratory symptoms within the three groups: 73.7% in group 1, 24.2% in group 2, and 100% in group 3 (p-value: <0.001). Surgery was considered in the presence of symptoms in patients with DAA and in those with reduction of the tracheal section area greater than 50%. A total of 52.5% of the patients underwent surgical repair (median age 6 months). The median follow-up interval was 21.9 months. Respiratory symptoms improved in most symptomatic patients. Conclusions No specific protocols are available for the management of patients with AAMs. Conservative treatment seems to be reasonable for asymptomatic patients or those with airway stenosis less than 50%. A close follow-up is necessary to identify early patients who become symptomatic.
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Affiliation(s)
- Francesca Petreschi
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Coretti
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Marilena Trozzi
- Airway Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annalisa Allegorico
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Adriano Carotti
- Unit of Complex Cardiac Surgery with Innovative Techniques, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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5
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Rossanese M, Cinti F, Chanoit GPA, Brockman DJ. Clinical findings, surgical treatment and long-term outcome of dogs and cats with double aortic arch: four cases (2005-2022). J Small Anim Pract 2022; 63:834-842. [PMID: 35971668 DOI: 10.1111/jsap.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/22/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the clinical presentation, diagnostic findings, treatment and long-term outcome following surgery of dogs and cats undergoing surgical treatment for a double aortic arch. MATERIALS AND METHODS Medical records of dogs and cats diagnosed with a double aortic arch between 2005 and 2022 at three small animal referral hospitals were retrospectively reviewed. Long-term outcome was assessed by a clinical examination and/or by contacting the owners or referring veterinarians. RESULTS Two dogs and two cats were included. Regurgitation after eating, stunted growth and poor weight gain were the predominant clinical features. All animals had thoracic radiography and oesophagography; a dilation of the cranial thoracic oesophagus cranial to the heart base, was described in all animals. CT angiography confirmed double aortic arch in three of these and the right aortic arch was larger and appeared more well developed compared with the left aortic arch in all based on CT or surgical findings. Surgery was performed via a left fourth intercostal thoracotomy; ligation and transection of the lesser left aortic arch was performed. Follow-up time ranged from 360 to 1563 days. All animals showed a marked improvement during the postoperative period, and all gained weight gradually. Owners' perception of the surgical procedure outcome and quality of life was described as excellent for all animals. CLINICAL SIGNIFICANCE Surgical ligation of the lesser aortic arch in dogs and cats with double aortic arch is associated with a favourable prognosis for recovery, resolution of clinical signs, and quality of life with only minor feeding modifications.
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Affiliation(s)
- M Rossanese
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, AL9 7TA, UK
| | - F Cinti
- Clinica Veterinaria Apuana-Anicura, Marina di Carrara, 54033, Italy
| | - G P A Chanoit
- Small Animal Referral Hospital Langford Vets, University of Bristol, Bristol, BS8 1TH, UK
| | - D J Brockman
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, AL9 7TA, UK
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Cardiovascular causes of tracheobronchial compression: a decade experience in a Paediatric Congenital Heart Centre. Cardiol Young 2022; 32:374-382. [PMID: 34080535 DOI: 10.1017/s1047951121002110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Vascular compression of the airway often complicates CHD management. This study evaluated the use of CT in determining cardiovascular causes, clinical manifestations, and outcome of tracheobronchial compression among children with CHD. METHODS A retrospective review of clinical records of all patients with CT scan evidence of tracheobronchial compression from January 2007 to December 2017 at National Heart Institute. Cardiovascular causes of tracheobronchial compression were divided into three groups; group I: vascular ring/pulmonary artery sling, II: abnormally enlarged or malposition cardiovascular structure due to CHD, III: post-CHD surgery. RESULTS Vascular tracheobronchial compression was found in 81 out of 810 (10%) patients who underwent CT scan. Group I lesions were the leading causes of vascular tracheobronchial compression (55.5%), followed by group II (34.6%) and group III (9.9%). The median age of diagnosis in groups I, II, and III were 16.8 months, 3 months, and 15.6 months, respectively. Half of group I patients are manifested with stridor and one-third with recurrent chest infections. Persistent respiratory symptoms, lung atelectasis, or prolonged respiratory support requirement were clues in groups II and III. Higher morbidity and mortality in younger infants with severe obstructive airway symptoms, associated airway abnormalities, and underlying complex cyanotic CHD. CONCLUSIONS Vascular ring/pulmonary artery sling and abnormally enlarged or malposition cardiovascular structure were the leading causes of cardiovascular airway compression. A high index of suspicion is needed for early detection due to its non-specific presentation. The outcome often depends on the severity of airway obstruction and complexity of cardiac lesions.
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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.
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Bakhru S, Koneti NR, Patil S, Dhulipudi B, Dash T, Kolar G, Vavilala S. Prenatal diagnosis of vascular rings and outcome. Ann Pediatr Cardiol 2021; 14:359-365. [PMID: 34667409 PMCID: PMC8457289 DOI: 10.4103/apc.apc_108_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/08/2020] [Accepted: 11/22/2020] [Indexed: 11/11/2022] Open
Abstract
Background : Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan surgery after birth. Objectives : The purpose of the study was to see the feasibility of accurate diagnosis of VR during antenatal ultrasound examination and describe their outcome. Methods : This is a retrospective observational study between January 2014 and December 2019. Vascular rings were diagnosed on the basis of three vessel tracheal view and neck vessels arrangements on fetal echocardiogram. Postnatal evaluation by transthoracic echocardiography and computerized tomography angiogram was performed. Surgical repair was done as per standard indications. Results : A total of 35 cases of fetal VRs (median gestational age: 24 weeks [range: 19–35]) were diagnosed during the study period. There were four dichorionic diamniotic twin gestation pregnancies. The right aortic arch (RAA) with anomalous left subclavian artery (ALSA) was suspected in 31 fetuses, double aortic arch (DAA) in 3, and circumflex aorta in 1. Twenty-six (74%) patients had successful deliveries. One patient had a spontaneous miscarriage, 2 underwent termination, and 6 were lost to follow-up. Postnatal assessment showed RAA with ALSA in 18, DAA in 5, circumflex aorta in 2, and no abnormality in 1. Twenty-two (86%) were operated (RAA with ALSA: 17, DAA: 4, and circumflex aorta: 1) and four were waiting for surgery. Two patients died due to prematurity-related complications. All survivors are symptom free during follow-up (median: 2.24; range: 0.2–5.6 years). Conclusions : Fetal echocardiography enables prenatal diagnosis and planning of postnatal repair of VRs.
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Affiliation(s)
- Shweta Bakhru
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Nageswara Rao Koneti
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Sujata Patil
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Bhargavi Dhulipudi
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Tapan Dash
- Department of Pediatric Cardiology, Rainbow Children's Heart Institute, Hyderabad, Telangana, India
| | - Geeta Kolar
- Department of Fetal Medicine, Fernandez Hospital, Hyderabad, Telangana, India
| | - Suseela Vavilala
- Department of Fetal Medicine, Fernandez Hospital, Hyderabad, Telangana, India
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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.
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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
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Xu Y, Xu D, Cheng B, Tang L, Chen Z, Du L. A case report of pulmonary artery sling and situs inversus incompletes. Medicine (Baltimore) 2021; 100:e24021. [PMID: 33545997 PMCID: PMC7837816 DOI: 10.1097/md.0000000000024021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022] Open
Abstract
RATIONALE Pulmonary artery sling (PAS) is a rare congenital anomaly. Associated airway anomalies and/or those of the cardiovascular system are present in about half the patients. Situs inversus is a rare disease in which organs of the chest and/or abdomen are arranged in a mirror image reversal of their normal position. Herein, we report a rare case of pulmonary artery sling and situs inversus incompletus, which has not yet been reported. PATIENT CONCERNS A 10-year-old girl was admitted because of heart murmur for more than 9 years. On physical examination, the second heart sound was prominent, and a grade 2/6 systolic murmur was heard at the left mid-sternal border. Echocardiography revealed PAS and atrial septal defect (8.6 mm). A chest computer tomography angiograph demonstrated that she had lung inversus, right aortic arch, and right lung hypoplasia in addition to PAS, with a normal positioning of the heart. The PAS intersected and twisted across the bronchus, which was obviously narrowed. The PAS was type II B, since the carina was at the T6 level without a separate right upper lobe bronchus. DIAGNOSES Her final diagnosis was that of PAS, tracheal stenosis, situs inversus incompletus, right lung hypoplasia, right aortic arch, ASD and PDA. INTERVENTIONS She underwent one-stage total correction for her initial cardiovascular defects through median sternotomy under cardiopulmonary bypass support. OUTCOMES She had an uneventful recovery and completely healthy following the procedure. LESSONS A thorough examination before PAS surgery was essential in discovering and carefully evaluating complicated heart and lung anomalies.
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Affiliation(s)
| | - Dan Xu
- Department of Pulmonology
| | | | | | | | - Lizhong Du
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang Province, China
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Yubbu P, Devaraj NK, Sahadan DZ, Latiff HA. Vascular compression of the airways: Issues on management in children with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Priya S, Nagpal P. Atretic Double Aortic Arch: Imaging Appearance of a Rare Anomaly and Differentiation From Its Mimics. Cureus 2020; 12:e9478. [PMID: 32884866 PMCID: PMC7461656 DOI: 10.7759/cureus.9478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
A double aortic arch (DAA) with atresia is an uncommon cause of a symptomatic vascular ring resulting in trachea-esophageal compression. An atretic double aortic arch can resemble the right aortic arch with a mirror image branching pattern or the right arch with an aberrant left subclavian artery depending upon the level of atresia. The double aortic arch with atresia is difficult to detect on pre-surgical computed tomography angiography or magnetic resonance angiography due to a lack of contrast in the obliterated arch segment. Differentiation of a double arch with atresia from the right aortic arch is vital as an atretic double arch is a form of the complete vascular ring while the right aortic arch may or may not be symptomatic. Knowledge of some key imaging features can help distinguish these entities. In this case report, we discuss an uncommon case of a double aortic arch with atresia between the left common carotid and left subclavian artery. We also describe its close mimics, their embryological basis, and ways to differentiate it from the right aortic arch.
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Affiliation(s)
- Sarv Priya
- Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Prashant Nagpal
- Cardiothoracic Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
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Sezer S, Acar DK, Ekiz A, Kaya B, Bornaun H, Aslan H. Prenatal diagnosis of left pulmonary artery sling and review of literature. Echocardiography 2019; 36:1001-1004. [PMID: 30968436 DOI: 10.1111/echo.14325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 11/30/2022] Open
Abstract
Left pulmonary artery sling (LPAS) is a very rare cause of large airway compression. In LPAS, the left pulmonary artery (LPA) arises from the proximal right pulmonary artery, coursing over the right mainstem bronchus, posterior to the trachea and anterior to the esophagus prior to reaching the left hilum. The aberrant course of the LPA results in anatomical obstruction of the right mainstem bronchus, the trachea, or both. Only a few reports present the prenatal features of LPAS. In this report, we present the prenatal diagnosis of a case of LPAS in one of a set of identical twins in which the only feature was that of an abnormal course of the LPA on 3-vessel tracheal view. The cross-sectional view at the level of three vessels which includes both pulmonary artery branches is useful to detect this abnormality. Color and power Doppler may be helpful as well.
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Affiliation(s)
- Salim Sezer
- Department of Maternal Fetal Medicine, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Deniz Kanber Acar
- Department of Maternal Fetal Medicine, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Ali Ekiz
- Department of Maternal Fetal Medicine, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Başak Kaya
- Department of Maternal Fetal Medicine, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Helen Bornaun
- Department of Pediatric Cardiology, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
| | - Halil Aslan
- Department of Maternal Fetal Medicine, Kanuni Sultan Süleyman Education and Research Hospital, İstanbul, Turkey
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14
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Successful Surgical Therapy of a Double Aortic Arch in a 10-Month-Old Mixed Breed Dog. Case Rep Vet Med 2019; 2019:6519041. [PMID: 30906616 PMCID: PMC6393890 DOI: 10.1155/2019/6519041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/29/2019] [Indexed: 11/18/2022] Open
Abstract
A 10-month-old female spayed mixed breed dog with a suspected vascular ring anomaly was presented for exercise intolerance and wheezing. Computed tomography (CT) revealed a double aortic arch. The smaller right aortic arch was successfully ligated via right 4th intercostal thoracotomy. The patient was discharged one day postoperatively and continued to have good outcome at recheck 3.5 weeks after surgery. This is the 4th documented case of double aortic arch with a successful outcome. Preoperative CT scan was vital in preoperative planning and should be strongly recommended in all cases of suspected vascular ring anomalies with atypical presentation.
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15
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Zhu X, Wu C, He Y, Qin B, Yang H, Huang H, Ji X. 3D-Imaging evaluation of double aortic arch with MSCTA: A case report and mini-review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:103-109. [PMID: 28854527 DOI: 10.3233/xst-17270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Double aortic arch (DAA) is a rare congenital anomaly associated with the formation of a vascular ring. Patients with DAA commonly suffer from complications caused by intracardiac and extracardiac malformations and different degrees of airway stenosis. Multislice computed tomographic angiography (MSCTA) is an intuitive and effective medical imaging technique in clinical diagnosis of DAA. MSCTA can accurately manifest the aortic arch and the course of the descending aorta and airway stenosis in three-dimension (3D). It is important to diagnose and make an operative plan for DAA. In this paper, we present a case of DAA diagnosed by MSCTA with 3D-static images and rotated reconstruction images and performed a mini-review.
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Affiliation(s)
- Xu Zhu
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Chun Wu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yun He
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
- Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Qin
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Yang
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Hong Huang
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Xiaojuan Ji
- Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
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Alsaied T, Sticka J, Unaka N, Cooper DS, Manning PB. A Rare Case of Pulmonary Artery Sling and Complete Atrioventricular Canal Defect in an Infant With Trisomy 21. World J Pediatr Congenit Heart Surg 2017; 5:470-2. [PMID: 24958055 DOI: 10.1177/2150135114526422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/07/2014] [Indexed: 11/17/2022]
Abstract
Pulmonary artery sling is a very rare congenital vascular anomaly. Patients usually present in infancy with symptoms of airway compression. Patients with trisomy 21 often have upper airway obstruction, most commonly related to pharyngeal causes or subglottic stenosis. Although the incidence of congenital heart defects in patients with trisomy 21 is very high, a review of the literature showed only one previously reported case of pulmonary artery sling in an infant with trisomy 21. We report a case of pulmonary artery sling and complete atrioventricular canal defect in a one-month-old female with trisomy 21. Echocardiography is an important diagnostic method for pulmonary artery sling, but this anomaly may be easily overlooked in the presence of more commonly anticipated defects in this population.
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Affiliation(s)
- Tarek Alsaied
- Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joshua Sticka
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ndidi Unaka
- Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter B Manning
- Division of Pediatric Cardiothoracic surgery, St Louis Children's Hospital, 1 Childrens Pl, St Louis, MO, USA
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17
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François K, Panzer J, De Groote K, Vandekerckhove K, De Wolf D, De Wilde H, Marchau F, De Caluwe W, Benatar A, Bové T. Early and late outcomes after surgical management of congenital vascular rings. Eur J Pediatr 2017; 176:371-377. [PMID: 28091779 DOI: 10.1007/s00431-017-2850-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/01/2017] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED Persistent respiratory or feeding problems in children may be associated with a congenital vascular ring. Surgical management is fairly standardized, but long-term outcomes are not well described. This study aims to investigate clinical presentation, surgical treatment, and risk factors for early mortality and late outcome. Our database revealed 62 surgically treated vascular ring patients between 1993 and 2014. Double aortic arch was the most common diagnosis (53%). Median age at operation was 1 year. Symptoms were mainly respiratory (89%) and feeding problems (32%). Median extubation time and hospital stay were 4 h and 5 days. Mean follow-up was 7.8 ± 5.8 years. Early mortality was 8% and was related to anatomical diagnosis, concomitant anomalies, and a need for preoperative intubation. Freedom from residual symptoms at 1 and 6 months was 63 and 82%, respectively. Freedom from inhalation therapy at the last follow-up was 82% and was influenced by a type of vascular ring and preoperative ventilation. Dysphagia symptoms always disappeared. CONCLUSION Surgical relief of tracheoesophageal compression is commonly effective in vascular ring anomalies. Respiratory symptoms necessitating chronic inhalation therapy only persist in a minority of children. Patients with double aortic arch are at increased risk to remain symptomatic, particularly with infectious exacerbations.
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Affiliation(s)
- Katrien François
- Department of Congenital Cardiac Surgery, Cardiac Center, University Hospital Ghent, Ghent, Belgium.
| | - Joseph Panzer
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Katya De Groote
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Kristof Vandekerckhove
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Daniel De Wolf
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Hans De Wilde
- Department Pediatric Cardiology, Cardiac Center, University Hospital Ghent, Ghent, Belgium
| | - Fabienne Marchau
- Department of Pediatric Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Wim De Caluwe
- Department of Neonatology, Sint-Jan Hospital, Bruges, Belgium
| | - Abraham Benatar
- Department of Pediatric Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Thierry Bové
- Department of Congenital Cardiac Surgery, Cardiac Center, University Hospital Ghent, Ghent, Belgium
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Tola H, Ozturk E, Yildiz O, Erek E, Haydin S, Turkvatan A, Ergul Y, Guzeltas A, Bakir I. Assessment of children with vascular ring. Pediatr Int 2017; 59:134-140. [PMID: 27454661 DOI: 10.1111/ped.13101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 06/22/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vascular rings may cause pressure on the trachea and/or esophagus of varying degree, resulting in symptoms. This study assessed the presentation symptoms, diagnostic methods and treatment results after surgery in children with vascular ring. METHODS Symptomatic vascular ring patients undergoing surgery between January 2010 and August 2014 at Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, were retrospectively assessed. The presentation symptoms, demographic characteristics, and diagnostic tests were evaluated. Operative data and postoperative follow up, complications and problems were also examined in detail. RESULTS Twenty-one patients underwent surgery, 13 (63%) of whom were male. Median age was 12 months (range, 1 month-8 years). Among these patients, 62% (n = 13) had double aortic arch, 24% (n = 5) had right-sided aortic arch + ligamentum arteriosum, 10% (n = 2) had left-sided aortic arch + aberrant right subclavian artery, and 4% (n = 1) had pulmonary sling abnormality. Computed tomography (CT) angiography was performed in 17/21 patients. All the patients were successfully operated on. In the early postoperative period, two patients had chylothorax and one had nerve paralysis of nervus laryngeus recurrens. One patient died in the early period, and two patients had ongoing stridor on follow up. CONCLUSIONS CT angiography is effective for the differential diagnosis and visualization of vascular ring abnormality. In such cases, full recovery can be assured with early diagnosis and surgery.
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Affiliation(s)
- Hasan Tola
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Sertac Haydin
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Aysel Turkvatan
- Department of Radiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
| | - Ihsan Bakir
- Department of Pediatric Cardiovascular Surgery, Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Goot BH, Patel S, Fonseca B. Rapid 3D imaging of the lower airway by MRI in patients with congenital heart disease: A retrospective comparison of delayed volume interpolated breath-hold examination (VIBE) to turbo spin echo (TSE). CONGENIT HEART DIS 2016; 12:84-90. [PMID: 27611348 DOI: 10.1111/chd.12408] [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: 06/06/2016] [Revised: 08/06/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE When imaging the lower airway by MRI, the traditional technique turbo spin echo (TSE) results in high quality 2D images, however planning and acquisition times are lengthy. An alternative, delayed volume interpolated breath-holds examination (VIBE), is a 3D gradient echo technique that produces high spatial resolution imaging of the airway in one breath-hold. The objective of this study is to retrospectively evaluate the accuracy of lower airway measurements obtained by delayed VIBE when compared to TSE. DESIGN Patients with congenital heart disease who underwent a cardiac MRI (CMR) that included a delayed VIBE sequence from 5/2008 to 9/2013 were included. Standard TSE imaging was performed and delayed VIBE was acquired 5 min after gadolinium contrast administration. Airway measurements were made on both sequences by two observers in a blinded fashion to the other observer and other technique. Intraclass correlations (ICC) were calculated to assess for agreement between both techniques and the observers. RESULTS 29 studies met inclusion criteria with a mean patient age of 8.8 years (2 months to 63 years) and mean patient weight of 30.2 kg (3.5-110). All delayed VIBE and TSE sequences were found to be of diagnostic quality. Mean acquisition time was shorter for the delayed VIBE (13.1 seconds) than TSE (949.9 seconds). Overall there was very good agreement between the delayed VIBE and TSE measurements for both observers (ICC 0.78-0.94) with the exception of the distal right bronchus (ICC 0.67) The interobserver agreement was also excellent for both TSE (ICC 0.78-0.96) and VIBE (ICC 0.85-0.96). CONCLUSION Delayed VIBE is rapid and at least as accurate as the alternative TSE imaging for assessment of the lower airway by MRI across a wide spectrum of patients.
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Affiliation(s)
- Benjamin H Goot
- The Heart Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sonali Patel
- The Heart Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian Fonseca
- The Heart Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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20
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Bravo C, Gámez F, Pérez R, Álvarez T, De León-Luis J. Fetal Aortic Arch Anomalies: Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:237-251. [PMID: 26715656 DOI: 10.7863/ultra.15.02063] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/23/2015] [Indexed: 06/05/2023]
Abstract
Aortic arch anomalies are present in 1% to 2% of the general population and are commonly associated with congenital heart disease, chromosomal defects, and tracheaesophageal compression in postnatal life. The sonographically based detection of aortic arch anomalies lies in the 3-vessel and trachea view. Although highly sensitive, this view alone does not allow identification of the aortic arch branching pattern, which prevents an accurate diagnosis. The systematic addition of a subclavian artery view as part of a standardized procedure may be useful in the differential diagnosis of these conditions. We describe the sonographic assessment of fetal aortic arch anomalies by combining 2 fetal transverse views: the 3-vessel and trachea view and the subclavian artery view, which are included in the cardiovascular system sonographic evaluation protocol. We also review the sonographic findings and the clinical implications of fetal aortic arch anomalies.
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Affiliation(s)
- Coral Bravo
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Francisco Gámez
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Ricardo Pérez
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Teresa Álvarez
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.)
| | - Juan De León-Luis
- Departments of Obstetrics and Gynecology (C.B.A., F.G., R.P., J.D.L.-L.) and Pediatric Cardiology (T.Á.), Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; and Department of Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Universidad de Alcalá de Henares, Madrid, Spain (C.B.A.).
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21
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Fan GQ, Fang GQ, Li J, Xu F, Fu YQ, Chen YF, Ji XJ, Zheng HL, Chen SS. Diagnosis and Management of 60 Children with Congenital Vascular Rings: A 10-year Experience. Chin Med J (Engl) 2015; 128:1689-92. [PMID: 26063376 PMCID: PMC4733757 DOI: 10.4103/0366-6999.158381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Jing Li
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
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22
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Licari A, Manca E, Rispoli GA, Mannarino S, Pelizzo G, Marseglia GL. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol 2015; 50:511-24. [PMID: 25604054 DOI: 10.1002/ppul.23152] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 11/11/2022]
Abstract
Vascular rings are congenital anomalies that lead to variable degrees of respiratory problems or feeding difficulties by forming a complete or partial ring compressing the trachea, the bronchi, and the esophagus. The clinical diagnosis of vascular rings is often challenging for the pediatrician because the clinical manifestations are heterogeneous and nonspecific. Symptoms can vary from wheezing, stridor, dyspnea, and/or dysphagia to life-threatening conditions; however, they may not be present. The aim of this study is to review the recent literature on this subject and describe new developments in diagnostics and imaging.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
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23
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Smith BM, Lu JC, Dorfman AL, Mahani MG, Agarwal PP. Rings and slings revisited. Magn Reson Imaging Clin N Am 2014; 23:127-35. [PMID: 25476681 DOI: 10.1016/j.mric.2014.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vascular rings and pulmonary artery slings are rare congenital anomalies that often present with symptoms of tracheal and esophageal compression. These can involve the aortic arch branches and pulmonary arteries, respectively. This review illustrates the current role of MR imaging, highlights its advantages, and provides insight into the diagnosis of these anomalies by describing the embryology and characteristic imaging features of these lesions.
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Affiliation(s)
- Brandon M Smith
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA.
| | - Jimmy C Lu
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA; Division of Pediatric Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Adam L Dorfman
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA; Division of Pediatric Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Maryam Ghadimi Mahani
- Division of Pediatric Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Prachi P Agarwal
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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24
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Sling pulmonar de diagnóstico casual. An Pediatr (Barc) 2014; 80:267-8. [DOI: 10.1016/j.anpedi.2013.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 11/20/2022] Open
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25
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Chung HH, Baek JY, Lee WY, Jang JH, Jeong MY, Woo GH, Park SI, Kim IK. An adult asymptomatic pulmonary artery sling. Yeungnam Univ J Med 2014. [DOI: 10.12701/yujm.2014.31.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Han Hee Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Yeol Baek
- Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea
| | - Won Yik Lee
- Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, Korea
| | - Ji Hye Jang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Young Jeong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gi Hyeon Woo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Il Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Il Kyu Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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26
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Anomalous origin of the left pulmonary artery from the right pulmonary artery (pulmonary artery sling). Anesthesiology 2013; 119:1470. [PMID: 23358129 DOI: 10.1097/aln.0b013e31828744dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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