World Journal for Pediatric and
Congenital Heart Surgery
2016, Vol. 7(6) 717-720
Submitted April 8, 2016; Accepted June 27, 2016
© The Author(s) 2016
DOI: 10.1177/2150135116661279
Vascular Ring Diagnosis
and Management: Notable Trends Over 25 Years
Author
William N Evans, MD, Ruben J Acherman, MD, Michael L Ciccolo,
MD, Sergio A Carrillo, MD, Gary A Mayman, MD, Carlos
F Luna, MD, Robert C Rollins, MD,
William J Castillo, MD, Humberto Restrepo, MD, MPH
Source
ChildrenÕs Heart Center Nevada, 3006 S
Maryland Pkwy, Ste 690, Las Vegas, Nevada 89109, USA.
Email: wnevans50@aol.com.
Abstract
Background: Vascular rings (VRs) are
recognized as uncommon but not rare cardiovascular malformations. Methods: We analyzed data from all
patients born in Southern Nevada, who underwent diagnosis and management of VR
from 1990 to 2015, Results: From 1990 to 2015, a total
of 92 patients were diagnosed prenatally and postnatally. Of the 92 patients,
73 (79%) had right aortic arch and aberrant left subclavian artery (RAA-ALS)
with a left ductus arteriosus or ligamentum, 17 (19%) had a double aortic arch
(DAA), and 2 (2%) had a pulmonary artery sling. Of the 92 patients, 75 had an
isolated VR and 17 VR had significant additional congenital heart disease
(CHD). Of the 75 patients with an isolated VR, 52 underwent surgical repair,
and the most common surgical diagnosis was DAA in 6 (66%) of 9 for the period
1990 to 2005 versus less common in 9 (21%) of 43 during the period 2006 to
2015, P < .05. The isolated VR repair age significantly negatively
correlated with increasing time from 1990 to 2015, R._0.7 (P < .0001). Of
the 75 isolated VR, 23 remain asymptomatic. The 17 VR with CHD were treated
during infant palliation or intracardiac repair. Of
the total 92 VR, 60 were born after a 2004 community introduction of the three-
vessel fetal echocardiography view, from then the prenatal-detection rate has
significantly increasedÑ2004 to 2006, 0 (0%) of 9; 2007 to 2009, 1 (9%) of 11;
2010 to 2012, 11 (55%) of 20; and 2013 to 1015, 14 (70%) of 20 (P <
.0001). Conclusion: Over 25 years
in Southern Nevada, VR prenatal diagnosis has increased, isolated VR age at
surgery has decreased, and the percentage of those with RAA-ALS has increased.