SURGICAL-TREATMENT OF VASCULAR RINGS - THE MAYO-CLINIC EXPERIENCE

From 1947 through 1992, 37 Mayo Clinic patients underwent operation fo r the relief of tracheoesophageal obstruction that resulted from vascu lar rings and related entities. Of the 37 patients, 18 had a double ao rtic arch, 11 had a right aortic arch with an aberrant left subclavian artery, 4 had a left aortic arch with an aberrant right subclavian ar tery, 2 had a pulmonary artery sling, 1 had a right aortic arch with m irror-image branching and a left ligamentum arteriosum, and 1 had a le ft aortic arch, a right descending aorta, and a right ductus arteriosu s. Symptoms consisted of stridor, recurrent respiratory infections, an d dysphagia. The anomaly was approached through a left thoracotomy in 31 patients, through a right thoracotomy in 4, and through a median st ernotomy in 2. Only one early postoperative death (3 %) and no late de aths occurred. At long-term follow-up (maximal duration, 45 years), th ree patients had residual symptomatic tracheomalacia, one of whom requ ired right middle and lower lobectomy for recurrent pneumonia. Magneti c resonance imaging is the imaging technique of choice for accurate de lineation of the vascular and tracheal anatomy. When patients are symp tomatic, vascular ring should be repaired. The surgical risk is minima l, and the long-term results are excellent.