Clinical analysis of surgical correction for congenital vascular ring in children in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAO Manchen , DONG Shuo , DUAN Yabing , SUN Yangxue , LI Jiachen , WANG Ju , WANG Qiang , LI Shoujun , HUA Zhongdong ,  YAN Jun

Department of Pediatric Cardiac Surgical Center, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

YAN Jun, Email: yanjun.1112@aliyun.com

Keywords：

Vascular ring; double aortic arch; right aortic arch; aberrant subclavian artery

DOI：

10.7507/1007-4848.202007084

Video：

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Objective To investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring.Methods The clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32 (55.2%) males and 26 (44.8%) females with a median age of 16.5 (2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed.Results There were 20 (34.5%) patients of double aortic arch, 22 (37.9%) patients of right aortic arch with left arterial duct or ligament, 15 (25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1 (1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0 (0-648) h, and the median hospital stay time was 14.5 (7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0 (1-62) months.Conclusion For children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.

Citation： GAO Manchen, DONG Shuo, DUAN Yabing, SUN Yangxue, LI Jiachen, WANG Ju, WANG Qiang, LI Shoujun, HUA Zhongdong, YAN Jun. Clinical analysis of surgical correction for congenital vascular ring in children in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1242-1247. doi: 10.7507/1007-4848.202007084 Copy

1.	Yoshimura N, Fukahara K, Yamashita A, et al. Congenital vascular ring. Surg Today, 2020, 50(10): 1151-1158.
2.	饶姣, 李虹, 刘琴, 等. 54 例婴儿先天性血管环的临床特征和治疗. 中华胸心血管外科杂志, 2018, 34(11): 679-682.
3.	Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: A comprehensive review. Gen Thorac Cardiovasc Surg, 2015, 63(5): 245-259.
4.	Backer CL, Mavroudis C. Congenital heart surgery nomenclature and database project: Vascular rings, tracheal stenosis, pectus excavatum. Ann Thorac Surg, 2000, 69(4 Suppl): S308-S318.
5.	Franklin RCG, Béland MJ, Colan SD, et al. Nomenclature for congenital and paediatric cardiac disease: The International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Iteration of the International Classification of Diseases (ICD-11). Cardiol Young, 2017, 27(10): 1872-1938.
6.	Ruzmetov M, Vijay P, Rodefeld MD, et al. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: A 38-year single institution experience. J Pediatr Surg, 2009, 44(7): 1328-1332.
7.	Naimo PS, Fricke TA, Donald JS, et al. Long-term outcomes of complete vascular ring division in children: A 36-year experience from a single institution. Interact Cardiovasc Thorac Surg, 2017, 24(2): 234-239.
8.	Backer CL, Mongé MC, Popescu AR, et al. Vascular rings. Semin Pediatr Surg, 2016, 25(3): 165-175.
9.	Yang Y, Jin X, Pan Z, et al. Diagnosis and surgical repair of congenital double aortic arch in infants. J Cardiothorac Surg, 2019, 14(1): 160.
10.	Vinnakota A, Idrees JJ, Rosinski BF, et al. Outcomes of repair of Kommerell diverticulum. Ann Thorac Surg, 2019, 108(6): 1745-1750.
11.	Cinà CS, Althani H, Pasenau J, et al. Kommerell's diverticulum and right-sided aortic arch: A cohort study and review of the literature. J Vasc Surg, 2004, 39(1): 131-139.
12.	Backer CL, Mongé MC, Russell HM, et al. Reoperation after vascular ring repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2014, 17(1): 48-55.
13.	杨盛春, 马力, 夏园生, 等. 小儿完全性血管环合并 Kommerell 憩室的外科处理. 岭南心血管病杂志, 2017, 23(2): 171-174.
14.	Choi Y, Chung SB, Kim MS. Prevalence and anatomy of aberrant right subclavian artery evaluated by computed tomographic angiography at a single institution in Korea. J Korean Neurosurg Soc, 2019, 62(2): 175-182.
15.	Peng E, McAllister K, Walker A, et al. Surgical approach for hypoplastic mirror circumflex aortic arch. Ann Thorac Surg, 2019, 107(5): e313-e315.
16.	Bryant R, Wallen W, Rizwan R, et al. Modified aortic uncrossing procedure: A novel approach for norwood palliation of complex univentricular congenital heart disease with a circumflex aorta. World J Pediatr Congenit Heart Surg, 2017, 8(4): 507-510.
17.	Planché C, Lacour-Gayet F. Aortic uncrossing for compressive circumflex aorta. 3 cases. Presse Med, 1984, 13(21): 1331-1332.

1. Yoshimura N, Fukahara K, Yamashita A, et al. Congenital vascular ring. Surg Today, 2020, 50(10): 1151-1158.
2. 饶姣, 李虹, 刘琴, 等. 54 例婴儿先天性血管环的临床特征和治疗. 中华胸心血管外科杂志, 2018, 34(11): 679-682.
3. Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: A comprehensive review. Gen Thorac Cardiovasc Surg, 2015, 63(5): 245-259.
4. Backer CL, Mavroudis C. Congenital heart surgery nomenclature and database project: Vascular rings, tracheal stenosis, pectus excavatum. Ann Thorac Surg, 2000, 69(4 Suppl): S308-S318.
5. Franklin RCG, Béland MJ, Colan SD, et al. Nomenclature for congenital and paediatric cardiac disease: The International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Iteration of the International Classification of Diseases (ICD-11). Cardiol Young, 2017, 27(10): 1872-1938.
6. Ruzmetov M, Vijay P, Rodefeld MD, et al. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: A 38-year single institution experience. J Pediatr Surg, 2009, 44(7): 1328-1332.
7. Naimo PS, Fricke TA, Donald JS, et al. Long-term outcomes of complete vascular ring division in children: A 36-year experience from a single institution. Interact Cardiovasc Thorac Surg, 2017, 24(2): 234-239.
8. Backer CL, Mongé MC, Popescu AR, et al. Vascular rings. Semin Pediatr Surg, 2016, 25(3): 165-175.
9. Yang Y, Jin X, Pan Z, et al. Diagnosis and surgical repair of congenital double aortic arch in infants. J Cardiothorac Surg, 2019, 14(1): 160.
10. Vinnakota A, Idrees JJ, Rosinski BF, et al. Outcomes of repair of Kommerell diverticulum. Ann Thorac Surg, 2019, 108(6): 1745-1750.
11. Cinà CS, Althani H, Pasenau J, et al. Kommerell's diverticulum and right-sided aortic arch: A cohort study and review of the literature. J Vasc Surg, 2004, 39(1): 131-139.
12. Backer CL, Mongé MC, Russell HM, et al. Reoperation after vascular ring repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2014, 17(1): 48-55.
13. 杨盛春, 马力, 夏园生, 等. 小儿完全性血管环合并 Kommerell 憩室的外科处理. 岭南心血管病杂志, 2017, 23(2): 171-174.
14. Choi Y, Chung SB, Kim MS. Prevalence and anatomy of aberrant right subclavian artery evaluated by computed tomographic angiography at a single institution in Korea. J Korean Neurosurg Soc, 2019, 62(2): 175-182.
15. Peng E, McAllister K, Walker A, et al. Surgical approach for hypoplastic mirror circumflex aortic arch. Ann Thorac Surg, 2019, 107(5): e313-e315.
16. Bryant R, Wallen W, Rizwan R, et al. Modified aortic uncrossing procedure: A novel approach for norwood palliation of complex univentricular congenital heart disease with a circumflex aorta. World J Pediatr Congenit Heart Surg, 2017, 8(4): 507-510.
17. Planché C, Lacour-Gayet F. Aortic uncrossing for compressive circumflex aorta. 3 cases. Presse Med, 1984, 13(21): 1331-1332.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of surgical correction for congenital vascular ring in children in a single center

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