Treatment Of Vascular Ring Research Articles

374 Thoracotomy vs Video-assisted Thoracoscopic Surgery in the Treatment of Vascular Rings

Abstract Aim This review aims to investigate the procedure itself, post-operative complication rates and long-term outcomes of both VATS procedures and thoracotomy procedures in the treatment of VRs. Method A literature search of the MEDLINE and SCOPUS databases were performed at the projects inception to present. From the 361 articles retrieved, 271 were excluded. After applying the exclusion criteria and thorough manual screening, 14 studies were included in the review. 6 of these studies investigated the outcomes using thoracotomy, 3 case reports plus 2 studies that investigated the outcomes using VATS and 3 studies that directly compared the two procedures. All 11 studies were retrospectively performed with 4 studies collecting data for over 20 years, 2 studies over 10 years and the remaining studies collected data for 2–8 years. Results Overall, 590 cases in this review focused on using thoracotomy operations and 190 cases used VATS. The main themes from the results of the literature included: type of vascular ring identified, case and collection period of the studies, the surgical approach, post-operative complications, length of stay in hospital, symptom resolution, reoperation rates and mortality. In this review, VATS demonstrated reduced length of stay in hospital, lower reoperation rates and a lower mortality rate than the thoracotomy studies. The results indicated similar rates in operating time and rates of post-operative complications between the two procedures. Conclusions This review provides insight into the encouraging outcomes in the use of VATS compared to the thoracotomy cases which is the gold standard approach in vascular ring surgery.

Surgical treatment of vascular ring resulting in the formation of left aortic arch

Highlights. The described clinical case of surgical treatment of congenital anomaly of the aortic arch is of high interest to specialists due to the relatively late manifestation of symptoms, low incidence of the anomaly, prior surgical treatment of congenital heart disease in medical history, and characteristics of surgical intervention.Background. The described clinical case reports successful treatment of vascular ring formed by right aortic arch with aberrant left subclavian artery. The described clinical case of surgical treatment of congenital anomaly of the aortic arch is of high interest to specialists due to the relatively late manifestation of symptoms, low incidence of the anomaly in the population, prior surgical treatment of congenital heart disease in medical history, and the outcome of surgical treatment - newly formed left aortic arch.

Experience of ultrasound diagnostics of vascular rings and its influence on surgical treatment

Contemporary methods diagnose congenital heart diseases (CHD) with high accuracy but postnatal diagnostics of vascular rings (VR) remains difficult. From 2004 to 2017 in our Center were performed 7740 primary fetal echocardiograms and more than 65,000 echocardiograms for children. From 2004 to 2017 18589 operations of congenital heart disease were performed, of them 95 (0,51%) were VR surgery. Of all patients treated with VR 21 (22,1%) had prenatal diagnosis, 74 (77,9%) – had postnatal. Since 2011 during postnatal and prenatal echocardiography, we introduced a new protocol with necessary views for VR visualization. Thanks to the use it increased the number of operations on the VR. Surgical treatment of VR has excellent results with low surgical risk. For the successful VR surgical treatment is necessary CT to perform for required to clarify the anatomy of the VR and the trachea. Prenatal and postnatal Echo can help of VR detection in a group of asymptomatic patients.

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

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

Disturbances in ex vivo vascular smooth muscle responses following exposure to Pasteurella haemolytica vaccines

Rats were vaccinated with saline (control) or one of the two commercially available Pasteurella haemolytica vaccines Presponse or Precon-PH. Animals were killed 3 days later and thoracic aorta removed for evaluation of the ex vivo biophysical responses to carbachol (CCh). In some experiments, vascular endothelium was mechanically removed. Vaccination of rats impairs the endothelial-dependent relaxation to CCh. In vessels with endothelium removed, the contractile response to CCh is converted into a relaxation following vaccination. Treatment of endothelial-denuded vascular rings ex vivo with methylene blue, a guanylate cyclase inhibitor, reduced the vaccination effect. Treatment of vascular rings with the superoxide dismutase inhibitor diethyldithiocarbamate, impairs the relaxant response of de-endothelialized vessels to CCh in Presponse vaccinated rats while enhancing the relaxation response of vessels from Precon-PH vaccinated rats. De-endothelialized vessels from vaccinated rats, but not control rats, relaxed in the presence of N-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of nitric oxide synthetase. Furthermore, in the presence of L-NMMA, the relaxant response to CCh is significantly enhanced by Precon-PH but not Presponse. The normal relaxant response to hydrogen peroxide is converted into a contraction following vaccination. Results suggest that exposure to commercially available P. haemolytica vaccines alters vascular smooth muscle reactivity to CCh and that several independent pathways may be altered.

Polymorphonuclear leukocytes relax human internal mammary artery and saphenous vein segments differently

This study was designed to examine the effects of polymorphonuclear leukocytes (PMNs) on human internal mammary artery (IMA) and saphenous vein (SV) segments obtained from patients undergoing coronary bypass surgery. PMNs (107/mL) caused a modest (39% ± 4%) relaxation of precontracted IMA rings, but only minimal (5% ± 2%) relaxation of SV rings (P < 0.01, relaxation of IMA vs SV rings). Relaxation of SV rings in response to endothelium-dependent vasodilator acetylcholine was also less than that of IMA rings (P < 0.01). PMN-induced vasorelaxation was not modified by treatment of vascular rings with indomethacin, but the vasorelaxation was potentiated by superoxide dismutase and inhibited by both oxyhemoglobin and methylene blue, suggesting that PMNs release a material similar to the endothelium-derived relaxing factor (EDRF). PMN-induced vasorelaxation was associated with a 75% increase (P < 0.02) in the cyclic guanosine monophosphate (GMP) content of the IMA rings and a 20% increase in cyclic GMP in SV rings. To determine the role of the endothelium in PMN-vessel wall interactions, IMA and SV segments were exposed to superoxide anions generated by a combination of xanthine followed by xanthine oxidase (X + XO). In these X + XO-treated IMA and SV segments, PMNs caused a marked relaxation (55% ± 9% and 22% ± 8%, respectively) and a three- to fourfold increase in vascular cyclic GMP content. However, PMN-induced relaxation and the increase in cyclic GMP were less (P < 0.02) in the SV than the IMA rings. In manually deendothelialized vascular rings, PMNs caused a marked relaxation. These observations suggest that isolated PMNs, release an EDRF-like material that causes relaxation of IMA and SV rings by increasing tissue cyclic GMP. The reduced relaxation potential of the SV rings may explain the higher incidence of closure of SV grafts as compared to IMA grafts in patients undergoing coronary artery bypass surgery.

先天性心疾患 血管輪の外科治療法成績

先天性心疾患 血管輪の外科治療法成績

Surgical treatment of vascular ring.

Seven patients with vascular ring have been operated upon since 1965 at the Keio University Hospital with one operative death and three late deaths. Four patients had double aortic arch and 3 had right aortic arch with left ductus arteriosus. The lesser arch was divided in the four cases of double aortic arch. Ductus or ligamentum was divided in the three cases of right aortic arch with left ductus arteriosus or ligamentum arteriosum. Respiratory distress seems to constitute major cause of post-operative death and complete relief from respiratory and swallowing difficulties was achieved in only two out of the seven cases.