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Cardiology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The most common vascular ring is caused by a double aortic arch encircling the trachea and oesophagus causing compression of these structures (Fig. 5.21). A right aortic arch combined with an aberrant subclavian artery passing behind the oesophagus with a duct or ligament can also complete a ring. Vascular rings can be associated with other cardiac lesions, typically VSD or conotruncal abnormalities. Vascular slings occur when the aberrant vasculature partially surrounds the trachea and oesophagus. The left pulmonary artery may arise from the right pulmonary artery and compress the trachea (Fig. 5.22). Sometimes there may be severe tracheal abnormalities including complete tracheal rings, which may need extensive tracheal reconstruction. An isolated aberrant subclavian artery is very common in normal children and is very rarely responsible for feeding problems.
Congenital Disorders of the Larynx, Trachea and Bronchi
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Patients with vascular rings tend to present earlier in life and with more severe airway symptoms than those with vascular slings. A barium swallow is diagnostic, showing a characteristic double impression upon the column of contrast, and an echocardiogram will confirm the anomaly. Surgical treatment, almost always necessary, is by dividing the lesser component of the ring, but there is invariably a localized area of tracheomalacia produced by the compression which may persist for months or even years.
Vascular rings
Published in Prem Puri, Newborn Surgery, 2017
Benjamin O. Bierbach, John Mark Redmond, Christopher Hart
A vascular ring is a rare congenital condition in which an anomalous configuration of the aortic arch or associated vessels surrounds the trachea and esophagus, to form a complete compressing ring around them. Several other related vascular anomalies involving aortic arch vessels do not form complete rings but have been grouped descriptively with vascular rings because they can produce similar symptoms related to compression of the trachea and or esophagus. In common usage, however, the definition of a complete vascular ring is extended to include pulmonary artery slings, which do not completely surround the trachea and esophagus but may compress them. Both complete and incomplete rings and slings are discussed in this chapter.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
The American Thoracic Society (ATS) published their clinical practice guidelines on the diagnostic evaluation of infants with recurrent or persistent wheezing. They evaluated the following questions: Should infants with persistent wheezing despite treatment with bronchodilators, inhaled corticosteroids or systemic corticosteroids undergo airway survey via flexible bronchoscopy and should a BAL be done? [46] Regarding both of these questions, very low-quality evidence was found. In the case of bronchoscopy, case series only were identified. Collectively, 1 364 patients were identified and 452 (33%) were found to have anatomical abnormalities that led to wheezing. This included tracheomalacia, bronchomalacia, vascular rings, and airway compression by a vascular structure. No serious complications of bronchoscopy were recorded, except for transient hypoxemia in 5–10% of cases [46].
Aortic arch anomalies detected in foetal life by echocardiography
Published in Journal of Obstetrics and Gynaecology, 2018
Funda Oztunc, Sezen Ugan Atik, Reyhan Dedeoglu, Mehmet Aytac Yuksel, Rıza Madazlı
Another type of aortic arch anomaly in our series was DAA which is a congenital malformation associated with the formation of a real vascular ring. Large surgical studies have reported that the most common anomaly of the aortic arch which causes tracheoesophageal compression is DAA (Shah et al. 2007). It can cause varying degrees of airway compression. This can be subclinical or clinical, manifesting as acute stridor, severe respiratory compromise or symptoms of chronic airway compression. Early surgical repair of a DAA has a favourable long-term prognosis; therefore prompt detection and intervention are required to prevent long-term morbidity. Our patient suffered from stridor and respiratory compromise after the delivery. Diagnose was confirmed by transthoracic echocardiography and CT. No other extra or intracardiac anomaly was presented. The baby was undertaken to surgical repair and did well during the follow up for one year.
Co-dominant double aortic arch: a rare cause of vascular ring causing tracheomalacia in a child
Published in Acta Cardiologica, 2021
Mélanie Léonard, Pierre-Julien Bruyère, Jean-Paul Sacré, Hedwige Boboli, Marie-Christine Seghaye
DAA is a rare aortic arch anomaly encircling completely the trachea and the oesophagus. It represents the most frequent form of encircling vascular rings that account for up to 1% of all congenital cardiovascular diseases. DAA is due to the absence of regression of the right fourth branchial arch during embryogenesis. DAA is associated most commonly with a right dominant arch, less commonly with a left dominant – and rarely with co-dominant arches as it was the case in our patient. Usually, the right – and left carotid- and sub-clavian arteries arise from the ipsilateral arch, both arches join the left descending aorta and the ligamentum arteriosum is left-sided. DAA may be isolated or associated with congenital cardiac diseases.