Vascular anomalies and tracheoesophageal compression: A single institution's 25-year experience

Background. Vascular rings are uncommon anomalies in which preferred strate gies for diagnosis and treatment may vary among institutions. In this repor t, we offer a description of our approach and a review of our 25-year exper ience. Methods. A retrospective review was conducted of all pediatric patients wit h symptomatic tracheoesophageal compression secondary to anomalies of the a ortic arch and great vessels diagnosed from 1974 to 2000. Results. Thirty-one patients (38%) of eighty-two patients (mean age, 1.7 ye ars), were identified with double aortic arch, 22 patients (27%) with right arch left ligamenturn, and 20 patients (24%) with innominate artery compre ssion. Our diagnostic approach emphasized barium esophagram, along with ech ocardiography. This regimen was found to be reliable for all cases except t hose with innominate artery compression for which bronchoscopy was preferre d, and except those with pulmonary artery sling for which computed tomograp hy or magnetic resonance imaging, in addition to bronchoscopy, were preferr ed. Left thoracotomy was the most common operative approach (70 of 82; 85%) . Ten patients (12%) had associated heart anomalies, and 6 (7%) patients un derwent repair. Complications occurred in 9 (11%) patients and led to death in 3 (4%) patients. Conclusions. In our practice, barium swallow and echocardiography are suffi cient in diagnosing and planning the operative strategy in the majority of cases, with notable exceptions. Definitive intraoperative delineation of ar ch anatomy minimizes the risk of misdiagnosis or inadequate treatment. (C) 2001 by The Society of Thoracic Surgeons.