Fisenne Danielle T, Burns Joseph, Dhar Arushi
Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA.
Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, USA.
Cureus. 2022 Apr 30;14(4):e24623. doi: 10.7759/cureus.24623. eCollection 2022 Apr.
Vascular rings are congenital abnormalities of the aortic arch vascular system that compress the trachea and esophagus. A review of long-term outcomes suggests that chronic feeding difficulties can persist following surgical repair of vascular rings. Previous reports of postoperative vascular ring division outcomes indicate that chronic esophageal symptoms may persist following repair, though most available data focuses on persistent respiratory symptoms. It is therefore the aim of this article to summarize and organize recent evidence reporting the frequency, presentation, and management of feeding difficulties following vascular ring repair in pediatric patients. Pathophysiologic mechanisms for postoperative esophageal symptoms may include residual compression from an unresected diverticulum of Kommerell or delayed repair leading to chronic esophageal dysmotility despite correction of esophageal compression. Guidance on the management of feeding difficulties following vascular ring repair is limited. The authors describe success in one case with nasogastric tube feeding and interdisciplinary evaluation. Consensus regarding the management of feeding difficulty following vascular ring repair is needed.
血管环是主动脉弓血管系统的先天性异常，可压迫气管和食管。对长期预后的回顾表明，血管环手术修复后慢性喂养困难可能持续存在。先前关于血管环分离术后预后的报告表明，修复后慢性食管症状可能持续存在，尽管大多数现有数据集中在持续性呼吸道症状上。因此，本文的目的是总结和整理近期有关小儿患者血管环修复后喂养困难的发生率、表现及管理的证据。术后食管症状的病理生理机制可能包括未切除的Kommerell憩室的残余压迫，或尽管食管压迫已得到纠正，但延迟修复导致慢性食管运动障碍。血管环修复后喂养困难管理的指导有限。作者描述了1例鼻胃管喂养和多学科评估成功的病例。需要就血管环修复后喂养困难的管理达成共识。
