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Mid-term results of vascular ring surgery

Part of: Surgery

Published online by Cambridge University Press:  15 November 2021

Gabriel Amir Open the ORCID record for Gabriel Amir [Opens in a new window] ,
Niv Soffair ,
Elchanan Bruckheimer ,
Elchanan Nachum ,
Tommy Shoenfeld ,
Amichai Rotstein ,
Georgy Frenkel  and
Einat Birk
Gabriel Amir*
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
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
Affiliation:
Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
Amichai Rotstein
Affiliation:
Department of Pediatric Cardiology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
Georgy Frenkel
Affiliation:
Division of Pediatric and Congenital Cardiac Surgery, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
Einat Birk
Affiliation:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Pediatric Cardiology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
*
Author for correspondence: Dr G. Amir, Division of Pediatric and Congenital Cardiac Surgery, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel. Tel: 972504057199. Fax: 97237604853. E-mail: [email protected]; [email protected]
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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.

Keywords

Vascular ring surgerysymptomslong term
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 9 , September 2022 , pp. 1415 - 1420
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Part of this work was presented as e-poster at the European Society of Cardiology Congress 2020.

Gabriel Amir and Niv Soffair contributed equally to this manuscript.

References

Powell, AJ, Mandell, VS. Nadas’ Pediatric Cardiology. Saunders Elsevier, Philadelphia, 2006.Google Scholar
Licari, A, Manca, E, Rispoli, GA, et al. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol 2015; 50: 511–524. DOI 10.1002/ppul.23152.CrossRefGoogle ScholarPubMed
Backer, CL, Mongé, MC, Popescu, AR, et al. Vascular rings. Semin Pediatr Surg 2016; 25: 165–175. DOI 10.1053/j.sempedsurg.2016.02.009.CrossRefGoogle ScholarPubMed
Turner, A, Gavel, G, Coutts, J. Vascular rings - presentation, investigation and outcome. Eur J Pediatr 2005; 164: 266–270. DOI 10.1007/s00431-004-1607-6.CrossRefGoogle ScholarPubMed
Dodge-Khatami, A, Tulevski, II, Hitchcock, JF, et al. Vascular rings and pulmonary arterial sling: from respiratory collapse to surgical cure, with emphasis on judicious imaging in the hi-tech era. Cardiol Young 2002; 12: 96–104. DOI 10.1017/s1047951102000239.CrossRefGoogle ScholarPubMed
Gross, RE. Surgical relief for tracheal obstruction from a vascular ring. N Engl J Med 1945; 233: 586–590. DOI 10.1056/nejm194511152332003.CrossRefGoogle ScholarPubMed
Herrin, MA, Zurakowski, D, Fynn-Thompson, F, et al. Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults. J Thorac Cardiovasc Surg 2017; 154: 607–615. DOI 10.1016/j.jtcvs.2017.01.058.CrossRefGoogle ScholarPubMed
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: 234–239. DOI 10.1093/icvts/ivw344.Google ScholarPubMed
Schmidt, AMS, Larsen, SH, Hjortdal, VE. Vascular ring: early and long-term mortality and morbidity after surgical repair. J Pediatr Surg 2018; 53: 1976–1979. DOI 10.1016/j.jpedsurg.2017.12.022.CrossRefGoogle ScholarPubMed
Woods, RK, Sharp, RJ, Holcomb, GW, et al. Vascular anomalies and tracheoesophageal compression: a single institution’s 25-year experience. Ann Thorac Surg 2001; 72: 434–438. DOI 10.1016/S0003-4975(01)02806-5.CrossRefGoogle ScholarPubMed
Luciano, D, Mitchell, J, Fraisse, A, et al. Kommerell diverticulum should be removed in children with vascular ring and aberrant left subclavian artery. Ann Thorac Surg 2015; 100: 2293–2297. DOI 10.1016/j.athoracsur.2015.06.093.CrossRefGoogle ScholarPubMed
François, K, Panzer, J, De Groote, K, et al. Early and late outcomes after surgical management of congenital vascular rings. Eur J Pediatr 2017; 176: 371–377. DOI 10.1007/s00431-017-2850-y.CrossRefGoogle ScholarPubMed
Liu, AH, et al. Childhood asthma. In: Kliegman, R, et al. (eds). Nelson Textbook of Pediatrics. Elsevier, Phialdelphia, PA, 2006: 1095–1115.Google Scholar
Humphrey, C, Duncan, K, Fletcher, S. Decade of experience with vascular rings at a single institution. Pediatrics 2006; 117: e903–e908.CrossRefGoogle ScholarPubMed
Backer, CL, Mongé, MC, Russell, HM, et al. Reoperation after vascular ring repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17: 48–55. DOI 10.1053/j.pcsu.2014.01.001.CrossRefGoogle ScholarPubMed
Razon, Y, Berant, M, Fogelman, R, et al. Prenatal diagnosis and outcome of right aortic arch without significant intracardiac anomaly. J Am Soc Echocardiogr 2014; 27: 1352–1358. DOI 10.1016/j.echo.2014.08.003.CrossRefGoogle ScholarPubMed
Backer, CL, Russell, HM, Wurlitzer, KC, et al. Primary resection of kommerell diverticulum and left subclavian artery transfer. Ann Thorac Surg 2012; 94: 1612–1617. DOI 10.1016/j.athoracsur.2012.05.101.CrossRefGoogle ScholarPubMed
Mascio, C. A few things about rings. Semin Thorac Cardiovasc Surg 2019; 31: 564–565. DOI 10.1053/j.semtcvs.2019.05.005.CrossRefGoogle ScholarPubMed
Bairdain, S, Smithers, CJ, Hamilton, TE, et al. Direct tracheobronchopexy to correct airway collapse due to severe tracheobronchomalacia: short-term outcomes in a series of 20 patients. J Pediatr Surg 2015; 50: 972–977. DOI 10.1016/j.jpedsurg.2015.03.016.CrossRefGoogle Scholar
Lawlor, C, Smithers, CJ, Hamilton, T, et al. Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy. Laryngoscope 2020; 130: E65–E74. DOI 10.1002/lary.27938.CrossRefGoogle ScholarPubMed