Abstract
Clinically, early diagnosis and treatment is important for survival of pediatric with vascular ring (VR) associated with congenital heart disease (CHD), and accurate evaluation of VR is a prerequisite for repair surgical. The study aimed to assess the quantitative characteristics of tracheal compression in pediatrics with VR and CHD using dual-source computed tomography (DSCT), and further provided effective information for surgical decisions. A total of 49 VR patients with CHD and 56 controls were enrolled. The tracheal quantitative measurements (short diameter, long diameter, tracheal area and tracheal length) were obtained, and the degree of tracheal compression was assessed. Our results indicated that VR associated with CHD may cause more serious and complex symptoms, and the greater tracheal compression were found on DSCT when more severe symptoms were present (r = 0.84). The degree of tracheal compression was significantly different within the VR group between those with and without surgery (P = 0.002). Finally, there were good agreement among (1-long diameter ratio), (1-short diameter ratio) and (1-area ratio) in patients and controls, respectively. This study indicated that DSCT enables provides accurate quantitative tracheal compression information for VR pediatrics associated with CHD, and evaluation of the degree of tracheal compression by 1-area ratio may contribute to the repair surgical of VR.
Highlights
Vascular ring (VR) anomalies are rare malformations of thoracic arch-derived vascular and ligamentous structures, and represent approximately 1% of congenital cardiovascular anomalies
Early diagnosis and treatment is important for the survival of vascular ring (VR) pediatric patients with congenital heart disease (CHD), and accurate evaluation of VR is a prerequisite for the surgical repair
As shown in our study, recurrent infections (85.7%), cyanosis (69.4%), and dyspnea (30.6%) were the most common symptoms, and several symptoms often occurred simultaneously, which differed from those of isolated VR15,16, indicated that the VR associated with CHD may cause more serious and complex symptoms
Summary
Right aortic arch (RAA) with aberrant left subclavian artery (ALSA, n = 11, 21.5%), or with left ductus arteriosus/ligamentum arteriosum (n = 7, 13.7%) presented as incomplete VR. At the level of the tracheal stenosis, tracheal parameters in all VR patients were significantly lower than those of controls (mean bias ± standard deviations): short diameter (0.57 ± 0.19 mm vs 0.84 ± 0.17 mm, P < 0.001), long diameter (0.79 ± 0.29 mm vs 0.96 ± 0.20 mm, P = 0.001), short/long diameter ratio (74.3 ± 14.2% vs 88.4 ± 7.5%, P < 0.001), tracheal area (0.44 ± 0.27 mm[2] vs 0.67 ± 0.27 mm[2], P < 0.001). The aortic arch level, there were no statistically significant differences in tracheal parameters between VR and control groups (Table 3). After we took several measures to reduce the radiation dose, the mean ED of patients was 1.57 ± 1.21 mSv and that of the controls was 1.39 ± 1.37 mSv
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