Divisions of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Divisions of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota.
Semin Thorac Cardiovasc Surg. 2021;33(2):492-500. doi: 10.1053/j.semtcvs.2020.09.013. Epub 2020 Sep 23.
Vascular rings (VRs) are rare aortic arch anomalies that may present with a wide variety of symptoms related to esophageal and/or airway compression. We reviewed our surgical experience in both symptomatic and asymptomatic children. All children (n = 58) who underwent surgical repair of VRs or slings (mean age 27.4 ± 45.60 months; 36 males [62%]) between March 2000 and April 2020 were included. The most common anatomic variant was a right aortic arch (RAA) with aberrant left subclavian artery (ALSCA) (n = 29; 50%). Kommerell's diverticulum was present in 23 of these patients (79%). The second most common variant was a double aortic arch (n = 22; 38%), followed by pulmonary artery sling (n = 4; 6%), RAA with mirror image branching and left ligamentum arteriosum (n = 3; 5.2%), and left aortic arch (LAA) with aberrant right subclavian artery (n = 1; 1.7%). One patient had a double ring with pulmonary artery sling and RAA with ALSCA. Symptoms were present in 42 patients (72%). Left lateral thoracotomy was the approach in 50 patients (86%), while sternotomy was used in 8 (14%). Symptomatic improvement occurred in the majority of symptomatic patients (93%). There was one perioperative mortality (1.7%) in the symptomatic group which was non-VR related. Morbidities included recurrent laryngeal nerve injury in three patients (5.2%) and transient chylothorax in two (3.4%). Persistence/recurrence of symptoms resulted in one early and one late reoperation. The mean follow-up was 3 ± 5 years. In the current era, VR repair in children including asymptomatic ones can be performed with excellent results. We recommend complete repair of RAA with aberrant LSCA by resection of Kommerell's diverticulum and translocation of the ALSCA to avoid recurrence.
血管环（VR）是罕见的主动脉弓畸形，可能表现出与食管和/或气道压迫相关的多种症状。我们回顾了我们在有症状和无症状儿童中进行的手术经验。所有（n=58）在 2000 年 3 月至 2020 年 4 月期间接受 VR 或吊带手术修复的儿童（平均年龄 27.4±45.60 个月；36 名男性[62%]）均包括在内。最常见的解剖变异是右主动脉弓（RAA）伴左锁骨下动脉异常（ALSCA）（n=29；50%）。这些患者中有 23 例（79%）存在 Kommerell 憩室。第二种最常见的变异是双主动脉弓（n=22；38%），其次是肺动脉吊带（n=4；6%）、RAA 伴镜像分支和左动脉韧带（n=3；5.2%），以及左主动脉弓（LAA）伴右锁骨下动脉异常（n=1；1.7%）。1 例患者同时存在肺动脉吊带和 RAA 伴 ALSCA 的双重环。42 例患者（72%）有症状。50 例患者（86%）采用左侧开胸入路，8 例患者（14%）采用胸骨切开术。大多数有症状的患者（93%）症状改善。在有症状的患者组中，有 1 例（1.7%）围手术期死亡与 VR 无关。并发症包括 3 例（5.2%）喉返神经损伤和 2 例（3.4%）短暂性乳糜胸。症状持续/复发导致 1 例早期和 1 例晚期再次手术。平均随访时间为 3±5 年。在当前时代，包括无症状儿童在内的 VR 修复可以取得极好的效果。我们建议通过切除 Kommerell 憩室和将 ALSCA 移位来完全修复 RAA 伴异常 LSCA，以避免复发。
