Vascular Rings56.15

Amoreena Howell

2 day old F

Dyspnea and cough, inspiratory stridorWorse with feeding

MRA

MRA

click on image

Vascular Rings

Complete vs. Partial• Double Aortic arch most common (40%)

– failure of regression of both the right and left fourth branchial arches

• Right aortic arch with left ligamentum arteriosum – highly associated with congenital heart defects (98% of

cases), particularly TOF • Anomalous left PA (vascular sling)

– rare, the left PA arises from the right PA

Barium Esophogram reveals indentationsMRI for complete anatomy

Aortic Development

Mangement• Medical if asymptomatic (careful feeding, soft foods, aggressive

tx of pulm infections)• Surgical division of ring if symptomatic

References

Myung K. Park, Pediatric Cardiology for Practitioners, 4th ed., St. Louis, Mosby Inc., 2002, pp. 241-246.

Townsend CM, Beauchamp ED, Evers BM, Mattox KL, Sabiston Textbook of Surgery, 17th ed., Philadephia, Elsevier, 2004, p. 1837

Collins-Nakai R, “How congenital heart disease originates in fetal life.” Cardiol Clin, 01-AUG-2002; 20(3): 367-83, v-vi