Simple Division of The Vascular Ring and Dissection of The Arch Is Enough To Relief Tracheosophageal Compression

  • Prof Mohamed-Adel Elgamal, Departments of Congenital & Pediatric Cardiac Surgery, Mansoura University Children's Hospital, Mansour, Egypt
  • Prof Hala AlMarsafawy, Pediatric Cardiology. Mansoura University Children's Hospital, Mansoura, Egypt
  • A/Prof Nour Eldin Gwely, Departments of Congenital & Pediatric Cardiac Surgery, Mansoura University Children's Hospital, Mansour, Egypt
  • Lecturer Gehan Alsawah, Pediatric Cardiology. Mansoura University Children's Hospital, Mansoura, Egypt

    • Background: Vascular rings represent less than 1% of all congenital cardiac defects. Some surgical litirature stressed the importance of aortopexy to prevent recurrence of the symptoms.
    Objective: To evaluate our intermediate-term results with just simple division, with full arch mobilization.
    Patients and Methods: From October 2004 to October 2008, 13 patients were diagnosed with vascular ring . Age ranged from 7 days to 44 months, there were 7 males and 6 females. Stridor was present in all patients. Echocardiography and CT angiography were done for all patients. Multisclice CT was done in last four patients.
    Results: Eight patients had double aortic arch, and 4 patients had right aortic arch with left ligamentum arteriosum and aberrant left subclavian artery, and one patient had pulmonary artery sling. Approach was through left posterolateral thoracotomy in all, but one patient. The non-dominant arch was dissected, divided and both ends were sutured. Full dissection of the divided arch and the dominant arch with complete removal of all fibrous bands between the arch and the trachea and esophagus was then done. There was no operative or late mortality. Three patients developed chylothorax, only one required thoracic duct ligation. Mean follw up was 30±5 months (range 4─48). All patients had full relieve of their symptoms.
    Conclusions: Simple division of the non-dominant arch with full mobilization of the dominant arch and removal of all adhesive fibrous bands between the arch and the trachea and esophagus is enough for cure. No need for additional surgical maneuvers.