Repair of a Complete Vascular Ring in a 2-Month-Old

The authors present the surgical repair of a complete vascular ring consisting of a double aortic arch in a 2-month-old boy who presented with noisy breathing and difficulty swallowing. Diagnosis was confirmed with a computed tomography scan, which showed a complete vascular ring consisting of a dominant right aortic arch and partially atretic left arch. The atretic segment was located between the left subclavian artery and the ductus diverticulum.

After induction of general endotracheal anesthesia, a paravertebral catheter was placed for postoperative pain management, in addition to placement of the necessary monitoring lines including cerebral and somatic near infrared spectroscopy (NIRS), left radial, and a femoral arterial line. In other terms, all four extremities were routinely monitored. The patient was positioned in the right lateral decubitus position. The left chest was entered through the left third intercostal space. The left lung was retracted medially, and the mediastinal pleura was opened on top of the esophagus and left subclavian artery. The authors take considerable time to identify all components of the vascular ring, which in this case were the left subclavian artery, right and left aortic arches, and ductus arteriosus. All arch vessels were visualized and dissected.