Diagnosis and treatment of vascular ring associated with congenital tracheal stenosis in infants

Abstract

Objective To investigate the operation method for congenital tracheal stenosis(CTS) with vascular ring(VR), in order to minimize surgical risk. Methods The data of 53 VR patients diagnosed by CT imaging, fiber bronchoscope and color doppler echocardiography were analyzed retrospectively.The age ranged from 5.0 days to 2.5 yeas old, median age was 12.5 months, including pulmonary artery sling, double aortic arch, right arch combined with abnormal left subclavian artery and innominate artery oppression, et al, in which 12 patients(8 male, 4 female) associa-ted with CTS symptoms.All patients were treated by operations, 8 patients were dead, others were followed up for 3 to 5 years at 6-month interval. Results Fifty-three patients with VR were categorized into 2 treatment groups.There were 41 patients(25 male, 16 female) without CTS symptoms treated by VR repair(3 cases died), mortality was 7.3%.Of the 12 patients(8 male, 4 female) with VR+ CTS symptoms, 7 cases were treated by selective VR repair with 2 cases deaths, 5 cases underwent combined VR and CTS repairs with 3 cases died, for an overall mortality of 41.7%.Of the 41 patients with VR but no CTS, 7 cases had intracardiac anomalies with 2 cases died.In contrast, 3 of 12 patients with VR+ CTS and intracardiac anomalies with 2 cases died; 5 patients received cardiac and CTS repairs(3 cases died) and 7 cases in selective VR repairs(2 cases died). Conclusions Not all cases of TN associated with VR require combined correction.CTS and the combined cardiac abnormalities increased the risk of VR surgery in children.The individualized treatment program should be developed for such children. Key words: Vascular ring; Congenital tracheal stenosis; Individualized; Infant