Early Surgical Management of Anatomically Complete Vascular Rings Brief Title: Screening for Anatomically Complete Vascular Rings

Abstract

Background Adults with potentially life-threatening congenital vascular anomalies due to tracheoesophageal compression and aneurysmal rupture are often misdiagnosed as having asthma or recurrent bronchopulmonary infection. However, the early recognition and treatment of these anomalies can help to achieve a low mortality rate. Early surgical treatment critically depends on early diagnosis, which still presents a challenge to doctors as it depends on an index of high clinical suspicion. We showed two-dimensional echocardiography (2DE) to be an effective tool for heart and great vessel examinations as it has a higher success rate and eliminates human error to a large extent. Purposes We explored the use of 2DE for the early diagnosis of anatomically complete vascular rings (ACVR) and its use as a tool to help plan a surgical strategy by determining possible surgical complications. Methods Two-dimensional echocardiography was used to diagnose anatomically complete vascular rings (including double aortic arch and right aortic arch with left ligamentum arteriosum) in 96 patients. They underwent a barium esophagogram, spiral CT and/or MRI to confirm the existence of the vascular rings. Demographics, historical objectives and the results of physical examinations were all taken into account when performing the clinical diagnosis, as opposed to the conventional methods that are used when diagnosing ACVR. Those patients with overt clinical symptoms of tracheoesophageal compression were then earmarked for surgical treatment. Results Among the patients diagnosed with ACVR, 64 received surgical treatment after ACVR was confirmed. Right aortic arch (RAA) with Kommerell's divertiuculum (KD) with left ligamentum arteriosum was found to be the most common type of ACVR (80.3% of cases). The diagnostic accuracy of 2DE was higher than conventional methods that depend on the clinical suspicion of symptoms of tracheoesophagal compression. Two-dimensional echocardiography was found to have a 100% overall sensitivity and a 100% specificity with regard to its ability to diagnose ACVR. Recurrent bronchopulmonary infections and asthmatic cough were the dominant symptoms of tracheal compression and all of these patients who underwent surgical treatment were well without morbidity and mortality. Conclusions Two-dimensional echocardiography is an effective primary diagnostic method with a high sensitivity and specificity. Early surgical management of ACVR is safe and easily achieved.