Vascular rings and pulmonary slings are a group of heterogeneous congenital malformation of the aortic arch, aortic branching vessels, and pulmonary arteries. Their unifying anatomical feature is the ability to encircle the trachea and esophagus with potential for extrinsic compression. The morphological heterogeneity is paralleled by a wide spectrum of clinical presentation, ranging from asymptomatic adult with incidental diagnosis to severe respiratory distress and dysphagia in the neonatal period. These anomalies account for 1 % of congenital cardiovascular malformation and are frequently associated with genetic defects and/or intracardiac congenital anomalies. Diagnostic workup includes routine tests such as chest X-ray and echocardiogram but often requires dedicated advanced cardiovascular imaging including computerized tomography scan, magnetic resonance imaging with angiography, and in selected cases invasive angiography.
Surgical correction is mandatory in symptomatic patients, in patients with potential for progressive compression and damage to the trachea or esophagus, or in patients with indication for surgical treatment of associated cardiac defects. Surgical approach is highly dependent on defect anatomy and may include sternotomy, thoracotomy, or in specific cases video-assisted thoracoscopic surgery. Surgical mortality and morbidity are usually low, and long-term freedom from reoperation is reassuring. Complex pathology of the trachea (such as long segmental stenosis) as seen in pulmonary arterial sling may complicate surgical repair, increasing at the same time the procedure mortality and jeopardizing long-term results.
Aortic Arch Compute Tomography Angiography Subclavian Artery Hypoplastic Left Heart Syndrome Left Pulmonary Artery
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Ganie IS, Amod K, Reddy D (2015) Vascular rings: a radiological review of anatomical variations. Cardiovasc J Afr 26:1–7Google Scholar
Woods RK, Sharp RJ, Holcomb GW 3rd, Snyder CL, Lofland GK, Ashcraft KW, Holder TM (2001) Vascular anomalies and tracheoesophageal compression: a single institution’s 25-year experience. Ann Thorac Surg 72(2):434–438; discussion 438–439CrossRefPubMedGoogle Scholar
McElhinney DB, Clark BJ 3rd, Weinberg PM, Kenton ML, McDonald-McGinn D, Driscoll DA, Zackai EH, Goldmuntz E (2001) Association of chromosome 22q11 deletion with isolated anomalies of aortic arch laterality and branching. J Am Coll Cardiol 37(8):2114–2119CrossRefPubMedGoogle Scholar
Backer CL, Mavroudis C (2000) Congenital Heart Surgery Nomenclature and Database Project: vascular rings, tracheal stenosis, pectus excavatum. Ann Thorac Surg 69(4 Suppl):S308–S318CrossRefPubMedGoogle Scholar
Stojanovska J, Cascade PN, Chong S, Quint LE, Sundaram B (2012) Embryology and imaging review of aortic arch anomalies. J Thorac Imaging 27(2):73–84CrossRefPubMedGoogle Scholar
Austin EH, Wolfe WG (1985) Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg 2(4):571–577CrossRefPubMedGoogle Scholar
Cinà CS, Althani H, Pasenau J, Abouzahr L (2004) Kommerell’s diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 39(1):131–139CrossRefPubMedGoogle Scholar
Tsang V, Murday A, Gillbe C, Goldstraw P (1989) Slide tracheoplasty for congenital funnel-shaped tracheal stenosis. Ann Thorac Surg 48(5):632–635CrossRefPubMedGoogle Scholar
Backer CL, Mavroudis C, Rigsby CK, Holinger LD (2005) Trends in vascular ring surgery. J Thorac Cardiovasc Surg 129(6):1339–1347CrossRefPubMedGoogle Scholar
Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW, Brown JW (2009) Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. J Pediatr Surg 44(7):1328–1332CrossRefPubMedGoogle Scholar
Yong MS, d’Udekem Y, Brizard CP, Robertson T, Robertson CF, Weintraub R, Konstantinov IE (2013) Surgical management of pulmonary artery sling in children. J Thorac Cardiovasc Surg 145(4):1033–1039CrossRefPubMedGoogle Scholar
Huang SC, Wu ET, Wang CC, Chen SJ, Chen YS, Chang CI, Chiu IS, Wang SS (2012) Surgical management of pulmonary artery sling: trachea diameter and outcomes with or without tracheoplasty. Pediatr Pulmonol 47(9):903–908CrossRefPubMedGoogle Scholar
Backer CL, Mavroudis C, Gerber ME, Holinger LD (2001) Tracheal surgery in children: an 18-year review of four techniques. Eur J Cardiothorac Surg 19(6):777–784CrossRefPubMedGoogle Scholar
Fanous N, Husain SA, Ruzmetov M, Rodefeld MD, Turrentine MW, Brown JW (2010) Anterior pericardial tracheoplasty for long-segment tracheal stenosis: long-term outcomes. J Thorac Cardiovasc Surg 139(1):18–23CrossRefPubMedGoogle Scholar
Manning PB, Rutter MJ, Lisec A, Gupta R, Marino BS (2011) One slide fits all: the versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children. J Thorac Cardiovasc Surg 141(1):155–161CrossRefPubMedGoogle Scholar