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Long-term outcomes in children undergoing vascular ring division: a multi-institution experience
European Journal of Cardio-Thoracic Surgery ( IF 3.1 ) Pub Date : 2021-10-11 , DOI: 10.1093/ejcts/ezab432
Di Yu 1 , Zhangke Guo 2 , Xin You 3 , Wei Peng 1 , Jirong Qi 1 , Jian Sun 1 , Kaihong Wu 1 , Xiaofeng Li 2 , Xuming Mo 1
Affiliation  

Abstract
OBJECTIVES
Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of patients with vascular ring division.
METHODS
A multi-institution retrospective review of 371 patients with vascular rings undergoing surgical division at 3 paediatric cardiac institutions between November 2007 and October 2019 was performed.
RESULTS
The complete vascular rings consisted of a double aortic arch (24.5%), right aortic arch with left ligamentum arteriosum (36.7%) and left aortic arch, with right ligamentum arteriosum (0.5%). The incomplete vascular rings consisted of a pulmonary artery sling (22.9%), left aortic arch with aberrant right subclavian artery (15.1%) and innominate artery compression syndrome (0.3%). Respiratory symptoms included stridor (71.4%), wheezing (49.1%), coughing (31.5%), gastrointestinal symptoms included choking (12.4%), dysphagia (3.2%) and emesis (1.9%). Only one patient died after discharge, yielding a late mortality rate of 0.3% (1/360). The 10-year overall survival rate was 96.8%. Postoperative complications were reported in 51 patients, 15 of whom required reoperation. The 10-year freedom from reoperation rate was 95.9%. Follow-up was completed in 95.4% (354/371) of patients, with a mean follow-up time of 4.3 ± 2.9 years (range from 1 to 13 years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up.
CONCLUSIONS
The outcomes of vascular ring division are excellent. A Kommerell diverticulum >1.5 times the aberrant left subclavian artery origin is an operative indication for primary resection. Tracheomalacia is a risk factor for reoperation and residual symptoms, and preoperative fibrobronchoscopy is important for evaluation.


中文翻译:

儿童血管环分裂的长期结果:多机构经验

摘要
目标
血管环是先天性心脏病的罕见异常,可引起呼吸道和胃肠道症状。本研究评估了血管环分裂患者的长期预后。
方法
对 2007 年 11 月至 2019 年 10 月在 3 个儿科心脏机构进行手术分割的 371 例血管环患者进行了多机构回顾性研究。
结果
完整的血管环由双主动脉弓(24.5%)、右主动脉弓和左动脉韧带(36.7%)和左主动脉弓和右动脉韧带(0.5%)组成。不完整的血管环包括肺动脉吊带(22.9%)、左主动脉弓伴右锁骨下动脉异常(15.1%)和无名动脉受压综合征(0.3%)。呼吸道症状包括喘鸣(71.4%)、喘息(49.1%)、咳嗽(31.5%),胃肠道症状包括窒息(12.4%)、吞咽困难(3.2%)和呕吐(1.9%)。只有一名患者在出院后死亡,晚期死亡率为 0.3% (1/360)。10年总生存率为96.8%。51 例患者报告了术后并发症,其中 15 例需要再次手术。10年无再手术率为95.9%。95年完成随访。4% (354/371) 的患者,平均随访时间为 4.3 ± 2.9 年(范围为 1 至 13 年)。20 名患者(5.6%)在长期随访期间出现残留症状。
结论
血管环分割的结果非常好。Kommerell 憩室 > 1.5 倍于异常的左锁骨下动脉起源是初次切除的手术指征。气管软化是再手术和残留症状的危险因素,术前纤支镜检查对评估很重要。
更新日期:2021-10-11
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