Symptoms
The body and lung blood flow is usually not mixed in these vascular malformations and therefore the patients do not stand out due to cyanosis. The trachea and oesophagus run within the vascular ring and can be compressed as the patient's body grows. As a result, a more pronounced breathing noise (stridor) and/or difficulty swallowing (dysphagia) can occur in infancy or later. Sometimes breathing difficulties are not recognised at an early stage or are misinterpreted as asthma. The diagnosis is often made during pregnancy.
Diagnosis
At the DHZC, we offer patients various diagnostic procedures. The most important examination methods are
- Echocardiography
- Magnetic resonance imaging (MRI)
- If necessary, bronchoscopy, in which a probe is inserted into the windpipe to examine it.
- Angiography if necessary
Therapy
Double aortic arch
If there is a double aortic arch, after opening the chest on the left side, the lungs are held out to the front and the left aortic arch (which lies in front of the trachea and oesophagus) and the right aortic arch (which runs behind the trachea and oesophagus) are exposed. The large vessels of the aortic arch and the ductus arteriosus (ligament) and the descending aorta (aorta) are mobilised widely. The ductus arteriosus and the aortic arch, which is smaller in diameter, are then cut off and severed. The ring is thus severed and the compression of the trachea and oesophagus is removed.
LPA sling
After opening the centre of the sternum, the malfunctioning left pulmonary artery is released from its connective tissue suspension. After starting the heart-lung machine, the left pulmonary artery can be separated from the right pulmonary artery and then pulled behind the trachea to the left side. The main trunk of the pulmonary artery is incised and the left pulmonary artery is reinserted on the correct (left) side of the main trunk.
Once the vascular ring has been severed, the patient is considered healthy. In the case of vascular loops, an exit stenosis of the reimplanted pulmonary artery may occur in the further course of the procedure.
