Reoperation to correct unsuccessful vascular ring and vascular decompression surgery

Labuz, Daniel F; Kamran, Ali; Jennings, Russell W.; Baird, Christopher W.

doi:10.1016/j.jtcvs.2021.08.089

Cited by 14 publications

(19 citation statements)

References 30 publications

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“…Left thoracotomy is the standard approach to divide a vascular ring with a right aortic arch. [1][2][3] The left ligamentum is divided. Aortopexy or resection of a Kommerell diverticulum with subclavian-carotid transposition may further relieve tracheoesophageal compression.…”

Section: Introductionmentioning

confidence: 99%

“…Aortopexy or resection of a Kommerell diverticulum with subclavian-carotid transposition may further relieve tracheoesophageal compression. Symptoms resolve in greater than 90% of patients who undergo surgical repair, [1][2][3] most commonly via left thoracotomy. However, symptoms may persist or recur in 5% to 10% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…However, symptoms may persist or recur in 5% to 10% of patients. [1][2][3] In patients with ongoing symptoms, redo ipsilateral thoracotomy may be performed to resect a Kommerell diverticulum and transpose the aberrant left subclavian artery to the left carotid artery. 1,2 However, this approach may present technical challenges and risks.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] In patients with ongoing symptoms, redo ipsilateral thoracotomy may be performed to resect a Kommerell diverticulum and transpose the aberrant left subclavian artery to the left carotid artery. 1,2 However, this approach may present technical challenges and risks. As an alternative approach in the reoperative setting, we describe left subclavian-carotid artery transposition via supraclavicular incision followed by resection of a Kommerell diverticulum via right thoracotomy with extracorporeal circulation.…”

Section: Introductionmentioning

confidence: 99%

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Contralateral Thoracotomy With Extracorporeal Circulation for Reoperative Resection of a Kommerell Diverticulum

Bartoli,

Rajakumar,

Elmore

et al. 2024

World J Pediatr Congenit Heart Surg

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Reoperative vascular ring surgery is uncommon. Standard redo ipsilateral thoracotomy may present technical challenges and risks. We describe a patient with right aortic arch, aberrant left subclavian artery, and a Kommerell diverticulum in whom previous vascular ring division via left thoracotomy did not relieve dysphagia. Three years after the unsuccessful operation, left subclavian–carotid transposition via supraclavicular incision followed by resection of the Kommerell diverticulum via right thoracotomy with extracorporeal circulation relieved symptoms. Contralateral thoracotomy with extracorporeal circulation provides a safe, alternative approach to redo ipsilateral thoracotomy for resection of a symptomatic Kommerell diverticulum. We review the literature on the incidence, surgical indications, and operative approaches to manage symptoms from a Kommerell diverticulum.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Contralateral Thoracotomy With Extracorporeal Circulation for Reoperative Resection of a Kommerell Diverticulum

Bartoli,

Rajakumar,

Elmore

et al. 2024

World J Pediatr Congenit Heart Surg

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“…Numerous things can lead to VR. VRs s can occur in 2 to 10 out of each 10,000 individuals [1]. Publications have provided descriptive data derived from comparatively small patient cohorts as a direct result of this.…”

Section: Introductionmentioning

confidence: 99%

The influence of prenatal screening on the contemporary operative outcomes and functional alleviation after vascular ring surgery in children

Verma¹,

Jhanwar²,

Singh³

2023

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Objective: The impact of prenatal screening on contemporary operative outcomes and functional alleviation during pediatric Vascular Ring Surgery (VRS) is analysed in this research. Methods:All patients who had surgical treatment of an isolated VR at the Texas Children’s Hospitalbetween 1996 and 2018were included in the study. Patients who simultaneously underwent intracardiac repair were disqualified. Other congenital cardiac conditions, clinical symptomatology, contemporary surgical intervention, perioperative outcome, reoperation rates, functional alleviation, and complications were all examined in the data analysis.To examine the data for this investigation, we employed SPSS 13.0.Results: 148 participants were chosen for analysis. Of the 148, 72(48.6%)have a Double Aortic Arch (DAA), 69(47.2%) have a ligamentum and a normal left subclavian artery or Right Aortic Arch (RAA) with a left-sided ductus, 5 (2.7%)have an RAA, Left Descending Aorta (LDA) and 2(1.3%) had RAA, Left Ligamentum Arteriosum (LLA), mirror-image branching. Right aortic arch vascular ring(RAAVR) aregeneral than Double Aortic Arch Vascular Ring (DAAVR): 31 patients had the earlier, with a frequency of 5.7 per 10,000 live births, whereas 6 patients had the latter, with an incidence of 1.1 per 10,000 live births (p = 0.0001).Conclusion: VRs are a prevalent form of congenital cardiovascular abnormality, especially when they affect the right aortic arch. Additionally, prenatal screening reveals a significant percentage of VRs.

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Outcomes of surgical treatment of tracheobronchomalacia in children

Mukharesh,

Krone,

Hamilton

et al. 2024

Pediatric Pulmonology

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BackgroundTracheobronchomalacia (TBM) is characterized by excessive dynamic airway collapse. Severe TBM can be associated with substantial morbidity. Children with secondary TBM associated with esophageal atresia/tracheoesophageal fistula (EA/TEF) and vascular‐related airway compression (VRAC) demonstrate clinical improvement following airway pexy surgery. It is unclear if children with severe primary TBM, without secondary etiologies (EA/TEF, vascular ring, intrinsic pulmonary pathology, or complex cardiac disease) demonstrate clinical improvement following airway pexy surgery.Materials and MethodsThe study cohort consisted of 73 children with severe primary TBM who underwent airway pexy surgery between 2013 and 2020 at Boston Children's Hospital. Pre‐ and postoperative symptoms as well as bronchoscopic findings were compared with Fisher exact test for categorical data and Student's t‐test for continuous data.ResultsStatistically significant improvements in clinical symptoms were observed, including cough, noisy breathing, prolonged respiratory infections, pneumonias, exercise intolerance, cyanotic spells, brief resolved unexplained events (BRUE), and noninvasive positive pressure ventilation (NIPPV) dependence. No significant differences were seen regarding oxygen dependence, ventilator dependence, or respiratory distress requiring NIPPV. Comparison of pre‐ and postoperative dynamic bronchoscopy findings revealed statistically significant improvement in the percent of airway collapse in all anatomic locations except at the level of the upper trachea (usually not malacic). Despite some initial improvements, 21 (29%) patients remained symptomatic and underwent additional airway pexies with improvement in symptoms.ConclusionAirway pexy surgery resulted in significant improvement in clinical symptoms and bronchoscopic findings for children with severe primary TBM; however, future prospective and long‐term studies are needed to confirm this benefit.

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Reoperation to correct unsuccessful vascular ring and vascular decompression surgery

Cited by 14 publications

References 30 publications

Contralateral Thoracotomy With Extracorporeal Circulation for Reoperative Resection of a Kommerell Diverticulum

Contralateral Thoracotomy With Extracorporeal Circulation for Reoperative Resection of a Kommerell Diverticulum

The influence of prenatal screening on the contemporary operative outcomes and functional alleviation after vascular ring surgery in children

Outcomes of surgical treatment of tracheobronchomalacia in children

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