IMAGING STRATEGIES FOR VASCULAR RINGS

Thirty-nine patients have undergone operation for relief of tracheoeso phageal compression resulting from vascular rings and related entities at the Mayo Clinic. Nineteen patients had a double aortic arch, 11 pa tients had a right aortic arch with an aberrant left subclavian artery , 5 patients had a left aortic arch with an aberrant right subclavian artery, 2 patients had a pulmonary artery sling, 1 patient had a right aortic arch with mirror-image branching and a left ligamentum arterio sum, and 1 patient had a left aortic arch, a right descending aorta, a nd a right ductus arteriosus. Diagnostic examinations included chest r adiography, barium esophagography, angiography, and, more recently, tr ansthoracic echocardiography, computed tomography, and magnetic resona nce imaging. A comparison among the various diagnostic techniques used in 12 patients during the last 12 years showed that angiography (n = 7), magnetic resonance imaging (n = 5), and computed tomography (n = 3 ) were the most reliable, as they always accurately delineated the ana tomy. However, in the 6 patients who underwent transthoracic echocardi ography, 1 of whom was an older child and 2 of whom were adults, the v ascular abnormality was described correctly only once; in the other 5 patients, the results were false-negative or the technique failed to v isualize the relevant vascular structures sufficiently. Currently, mag netic resonance imaging is our imaging technique of choice for the del ineation of the vascular and tracheal anatomy in patients suspected of having a vascular ring.