SURGICAL MANAGEMENT OF COMPLETE VASCULAR RINGS: OUR EXPERIENCE

Abstract

Vascular rings are rare congenital aortic arch anomalies that may cause trachea-esophageal compressive symptoms in infants and children. It may be asymptomatic in few cases. Due to its rare occurrence and non-specic symptoms, the diagnosis is often missed, thus delaying the treatment. With this case series we share our experience of managing four cases of vascular rings over four years, with age of patients ranging from 3 months to 3 years. All cases presented in pediatric emergency with trachea-esophageal compressive symptoms. In our series we encountered 4 types of complete vascular rings- Left Pulmonary Artery (LPA) sling with Left Ligamentum (LL), Right Aortic Arch with aberrant Left Subclavian Artery from Kommerell diverticulum with LL, Right dominant Double Aortic Arch (DAA) with associated TOF, and DAA with left dominant arch. Two cases had associated cardiac anomalies, which were Atrial Septal Defect (ASD) and Tetralogy Of Fallot (TOF). Median sternotomy was done in two cases with associated cardiac anomalies and left thoracotomy was the approach for rest two cases. Single stage single incision approach was followed in all cases, with no postoperative mortality and no signicant morbidity. Early diagnosis and precise planning of surgical intervention provides the best long-term outcomes.