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Vascular Ring

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Vascular Ring, Vascular Sling, Pulmonary Sling

  • See also
  1. Congenital Heart Disease
  2. Congenital Heart Disease Causes
  • Epidemiology
  1. Symptoms develop in first few months of life
  • Pathophysiology
  1. Large vessels apply local pressure
    1. Compress trachea and Bronchial tree
    2. Compress Esophagus
  • Causes
  1. Double aortic arch
  2. Aberrant innominate artery
  3. Right aortic arch
  4. Pulmonary Sling
  • Signs
  1. Low pitched inspiratory and expiratory gargling sounds
  2. Inspiratory Stridor
  3. Expiratory Wheezes
  4. Obstructive Sleep Apnea
  5. Feeding difficulties may occur
  6. Sounds present since birth
    1. Established over first month of life
    2. Parent may not be aware of sounds
  7. Provocative maneuvers that increase Dyspnea
    1. Neck flexion
    2. Upper Respiratory Infections
  8. Palliative maneuvers that decrease Dyspnea
    1. Neck extension
  • Radiology
  1. Chest XRay
    1. Note aortic arch location (right or left)
    2. Note tracheal caliber
  2. Barium swallow
    1. Note Esophageal indentation
  • Diagnostics
  1. Bronchoscopy
  2. Angiography
  • Course
  1. Respiratory symptoms worsen with increased age, size
  • Management
  1. Requires surgery
  • Complications
  1. Obstructive Sleep Apnea
  2. Tracheomalacia