Vascular Rings and Their Effect on Tracheal Geometry

Abstract

The major clinical impact of vascular rings in children is tracheal compression, which presents with recurrent symptoms of stridor, noisy breathing, and wheezing. This study tests the hypothesis that symptomatic patients have altered tracheal geometry compared to nonsymptomatic individuals. We retrospectively reviewed the tracheal dimensions (area and longest and shortest diameters) as visualized by magnetic resonance imaging from the cupola of the lung to the carina of 49 patients referred for evaluation of a vascular ring. The smallest dimension relative to the largest dimension (% of maximum) and the coefficient of variation (CoVar; standard deviation/mean) were assessed for each parameter. In all parameters measured (area and longest and shortest diameters), patients with symptoms due to vascular rings had significantly different values than patients without symptoms. The % of maximum was significantly smaller (area, 48.6 vs 62.1%; longest diameter, 41.0 vs 54.0%; shortest diameter, 45.0 vs 56.5%) and the CoVar was significantly greater (area, 0.26 vs 0.18; longest diameter, 0.31 vs 0.22; shortest diameter, 0.28 vs 0.19) in symptomatic individuals than in nonsymptomatic individuals. Patients with vascular rings who are symptomatic have significantly altered tracheal geometry compared to nonsymptomatic individuals. Magnetic resonance imaging is a useful tool for visualizing both the cardiovascular and the tracheal anatomy in patients with vascular rings and provides useful information for the management and care of these patients.

The presentation and management of vascular rings: An otolaryngology perspective

“…Patients with a double aortic arch present with predominant airway symptoms (stridor, respiratory distress, and cough). They also present earlier than the other vascular rings since the aerodigestive tract is completely encircled by the ring, rather than only being partially compressed [5,6].…”

“…Presenting symptoms correlate with the type of vascular ring. Airway symptoms are found more commonly when the trachea is compressed such as in a double aortic arch, while swallowing symptoms are seen when posterior compression of the esophagus occurs as in the aberrant subclavian artery [5,6].…”

“…According to several studies, direct laryngoscopy and bronchoscopy is not part of the routine evaluation of patients with vascular rings [3,[5][6][7][8]. Synchronous airway lesions (i.e.…”

Thoracoscopic division of vascular rings in infants and children

“…Our data and those of others [3,4] have shown that an esophagogram remains an excellent means for demonstrating the presence of a vascular ring. Perhaps the most attractive imaging modality available is the use of CT or magnetic resonance imaging [5][6][7]. Computed tomographic scan with contrast 3D volume rendering is a safe, fast, and noninvasive method for diagnosis.…”

Anatomical Assessment of Congenital Heart Disease

“…This is particularly important in post-operative patients where surgical clips would otherwise cause local image voids and anatomic disruption. Black-blood techniques have greatest utility when the relationships between airway and vessels must be elucidated (6). They are also vital for characterizing masses, thrombi, abdominal situs, hematomas or other soft tissue details (7).…”