Thoracoscopic division of vascular rings in infants and children.
OBJECTIVE
Traditionally vascular rings in infants and children are treated through an open thoracotomy. Recently, thoracoscopic surgery has been used for these complex procedures. This study reports our early experience with thoracoscopic division of vascular rings and evaluates the efficacy and safety of this approach.


METHODS
Patients who underwent thoracoscopic division of vascular rings at King Khalid University Hospital, Riyadh, Saudi Arabia, from December 2004 to January 2006 are included. Their data were carefully analyzed looking at demographics, clinical presentation, diagnostic modality, type of the anomaly, operative details, complications, and outcome.


RESULTS
A total of 9 patients underwent thoracoscopic division of vascular rings. Age at surgery ranged between 2 and 108 months (mean, 24 months). Weight varied between 5.3 and 32 kg (mean, 10.3 kg). All patients were symptomatic. Computed tomographic scan was diagnostic and accurately defined the type of anomaly in all the patients. Four patients had a right aortic arch with an aberrant left subclavian artery and left ductus/ligamentum arteriosum, 2 had double aortic arches, and 3 had a right aberrant subclavian artery. One patient developed right-sided pneumothorax on the contralateral site, and another one developed apnea 12 hours after surgery, requiring mechanical ventilation. There was no mortality. Operative time ranged between 50 and 145 minutes, the mean being 107 minutes. The average hospital stay was 4 days. Five patients had their preoperative symptoms completely resolved, and the rest are showing steady improvement. The average follow-up period is 6 months.


CONCLUSIONS
Our early experience indicates that thoracoscopic division of vascular rings is safe and effective. Because it takes away the need for thoracotomy, it is likely that it can result in less postoperative pain and rapid convalescence. It also prevents the ill effects of thoracotomy and gives good cosmetic results.
Al-Bassam
Abdulrahman
A
Division of Pediatric Surgery, Department of Surgery, King Khalid University Hospital and College of Medicine, King Saud University, PO Box 86572, Riyadh 11632, Saudi Arabia. abassam@ksu.edu.sa
Saquib Mallick
Mohammad
M
Al-Qahtani
Aayed
A
Al-Tokhais
Tariq
T
Gado
Abdulmonem
A
Al-Boukai
Ahmed
A
Thalag
Ahmed
A
Alsaadi
Muslem
M
D018376:Cardiovascular Abnormalities / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D004935:Esophageal Diseases / Q000151:congenital / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013906:Thoracoscopy; D014133:Tracheal Diseases / Q000151:congenital / Q000601:surgery*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000151:congenital / Q000601:surgery*