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 The left lung was retracted medially, and the mediastinal pleura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.
- Backer CL. Vascular rings with tracheoesophageal compression: management considerations. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2020;23:48-52.
- Backer CL, Mongé MC, Popescu AR, Eltayeb OM, Rastatter JC, Rigsby CK. Vascular rings. Semin Pediatr Surg. 2016 Jun;25(3):165-175.
- Backer CL, Bharadwaj SN, Eltayeb OM, Forbess JM, Popescu AR, Mongé MC. Double aortic arch with Kommerell diverticulum. Ann Thorac Surg. 2019 Jul;108(1):161-166.