DOI QR코드

DOI QR Code

Clinical Course of Vascular Rings and Risk Factors Associated With Mortality

  • Suh, Yoon-Jung (Department of Pediatrics Seoul National University Children's Hospital) ;
  • Kim, Gi-Beom (Department of Pediatrics Seoul National University Children's Hospital) ;
  • Kwon, Bo-Sang (Department of Pediatrics Seoul National University Children's Hospital) ;
  • Bae, Eun-Jung (Department of Pediatrics Seoul National University Children's Hospital) ;
  • Noh, Chung-Il (Department of Pediatrics Seoul National University Children's Hospital) ;
  • Lim, Hong-Gook (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Kim, Woong-Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Lee, Jeong-Ryul (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Kim, Yong-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital)
  • 발행 : 2012.04.30

초록

Background and Objectives: Vascular rings refer to anomalies of the great arteries that cause respiratory or feeding problems. The purpose of this study was to analyze a series of patients with vascular rings and evaluate associated risk factors for mortality. Subjects and Methods: A retrospective review of all patients identified with vascular rings between 1997 and 2010 in the Seoul National University Children's Hospital. Results: Thirty-five patients were diagnosed with vascular rings (median age at diagnosis, 7 months). The vascular rings of 32 patients were confirmed by cardiac computed tomography or magnetic resonance imaging. The types of vascular rings were: a double aortic arch in ten patients, a right aortic arch with persistent left ligamentum arteriosum in seven, an aberrant subclavian artery in seven, a pulmonary sling in eight, and others types in three patients. Eleven patients were asymptomatic. Gastrointestinal and respiratory symptoms were seen in ten and sixteen patients, respectively. Associated cardiovascular anomalies were present in fifteen patients. Twenty patients with definite symptoms underwent surgical treatment. The median interval between diagnosis and operation was 6 days. Four patients eventually died; three deaths were associated with complex heart diseases, and one had pulmonary artery sling with severe tracheal stenosis. Only the presence of a complex heart disease significantly influenced mortality (p=0.002). Conclusion: Vascular rings include several types of anomalies, each with a different prognosis and symptoms. The presence of a complex heart disease was significantly associated with mortality. Early diagnosis and timely surgery in symptomatic patients are essential.

키워드

참고문헌

  1. Kellenberger CJ. Aortic arch malformations. Pediatr Radiol 2010;40: 876-84. https://doi.org/10.1007/s00247-010-1607-9
  2. Hernanz-Schulman M. Vascular rings: a practical approach to imaging diagnosis. Pediatr Radiol 2005;35:961-79. https://doi.org/10.1007/s00247-005-1529-0
  3. Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW, Brown JW. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. J Pediatr Surg 2009;44:1328-32. https://doi.org/10.1016/j.jpedsurg.2008.11.062
  4. Banka P, Geva T, Powell AJ, Geggel R, Lahiri T, Valente AM. Images in cardiovascular medicine: right aortic arch with aberrant left innominate artery: a rare vascular ring. Circulation 2009;120:264-5. https://doi.org/10.1161/CIRCULATIONAHA.109.851733
  5. Eichhorn J, Fink C, Delorme S, Ulmer H. Rings, slings and other vascular abnormalities: ultrafast computed tomography and magnetic resonance angiography in pediatric cardiology. Z Kardiol 2004;93:201-8. https://doi.org/10.1007/s00392-004-0026-z
  6. Humphrey C, Duncan K, Fletcher S. Decade of experience with vascular rings at a single institution. Pediatrics 2006;117:e903-8. https://doi.org/10.1542/peds.2005-1674
  7. Dodge-Khatami A, Tulevski II, Hitchcock JF, de Mol BA, Bennink GB. 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. https://doi.org/10.1017/S1047951102000239
  8. Park MK. Vascular ring. In: Fletcher J, McGonigal C, editors. Pediatric Cardiology for Practitioners. 5th ed. Philadelphia: Mosby Elsevier;2008. p.303-6.
  9. Binet JP, Longlois J. Aortic arch anomalies in children and infants. J Thorac Cardiovasc Surg 1977;73:248.
  10. Gross RE. Surgical relief for tracheal obstruction from a vascular ring. N Engl J Med 1945;233:586-90. https://doi.org/10.1056/NEJM194511152332003
  11. Han BS, Kim CH, Oh BH, et al. A case of right sided aortic arch causing superior vena cava syndrome. Korean Circ J 1989;19:776-9. https://doi.org/10.4070/kcj.1989.19.4.776
  12. Bonnard A, Auber F, Fourcade L, Marchac V, Emond S, Revillon Y. Vascular ring abnormalities: a retrospective study of 62 cases. J Pediatr Surg 2003;38:539-43. https://doi.org/10.1053/jpsu.2003.50117
  13. Turner A, Gavel G, Coutts J. Vascular rings: presentation, investigation and outcome. Eur J Pediatr 2005;164:266-70. https://doi.org/10.1007/s00431-004-1607-6
  14. Woods RK, Sharp RJ, Holcomb GW 3rd, et al. Vascular anomalies and tracheoesophageal compression: a single institution's 25-year experience. Ann Thorac Surg 2001;72:434-8. https://doi.org/10.1016/S0003-4975(01)02806-5
  15. Alsenaidi K, Gurofsky R, Karamlou T, Williams WG, McCrindle BW. Management and outcomes of double aortic arch in 81 patients. Pediatrics 2006;118:e1336-41. https://doi.org/10.1542/peds.2006-1097
  16. Kocis KC, Midgley FM, Ruckman RN. Aortic arch complex anomalies: 20-year experience with symptoms, diagnosis, associated cardiac defects, and surgical repair. Pediatr Cardiol 1997;18:127-32. https://doi.org/10.1007/s002469900130

피인용 문헌

  1. Anomalous Origin of the Left Pulmonary Artery from the Right Pulmonary Artery (Pulmonary Artery Sling) vol.119, pp.6, 2012, https://doi.org/10.1097/aln.0b013e31828744dc
  2. A Rare Case of Pulmonary Artery Sling and Complete Atrioventricular Canal Defect in an Infant With Trisomy 21 vol.5, pp.3, 2012, https://doi.org/10.1177/2150135114526422
  3. 성인 무증상 폐동맥 슬링 vol.31, pp.2, 2012, https://doi.org/10.12701/yujm.2014.31.2.109
  4. Fetal Aortic Arch Anomalies : Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol vol.35, pp.2, 2012, https://doi.org/10.7863/ultra.15.02063
  5. Rapid 3D imaging of the lower airway by MRI in patients with congenital heart disease: A retrospective comparison of delayed volume interpolated breath-hold examination (VIBE) to turbo spin echo (TSE) vol.12, pp.1, 2017, https://doi.org/10.1111/chd.12408
  6. Vascular rings and slings: A challenging diagnostic and therapeutic rare disease entity vol.25, pp.4, 2012, https://doi.org/10.1016/j.jescts.2017.10.002
  7. Arteria Lusoria, reporte de un caso clínico vol.21, pp.1, 2012, https://doi.org/10.29375/01237047.2611
  8. Successful Surgical Therapy of a Double Aortic Arch in a 10-Month-Old Mixed Breed Dog vol.2019, pp.None, 2012, https://doi.org/10.1155/2019/6519041
  9. Prenatal diagnosis of left pulmonary artery sling and review of literature vol.36, pp.5, 2019, https://doi.org/10.1111/echo.14325
  10. Prenatal diagnosis of vascular rings and outcome vol.14, pp.3, 2012, https://doi.org/10.4103/apc.apc_108_20
  11. Vascular rings vol.30, pp.6, 2012, https://doi.org/10.1016/j.sempedsurg.2021.151128