title: Clinical course of vascular rings and risk factors associated with mortality.
abstract: OBJECTIVE
  Vascular rings refer to anomalies of the great arteries that cause respiratory or feeding problems. The purpose of this study was to analyze a series of patients with vascular rings and evaluate associated risk factors for mortality.
  
  
  METHODS
  A retrospective review of all patients identified with vascular rings between 1997 and 2010 in the Seoul National University Children's Hospital.
  
  
  RESULTS
  Thirty-five patients were diagnosed with vascular rings (median age at diagnosis, 7 months). The vascular rings of 32 patients were confirmed by cardiac computed tomography or magnetic resonance imaging. The types of vascular rings were: a double aortic arch in ten patients, a right aortic arch with persistent left ligamentum arteriosum in seven, an aberrant subclavian artery in seven, a pulmonary sling in eight, and others types in three patients. Eleven patients were asymptomatic. Gastrointestinal and respiratory symptoms were seen in ten and sixteen patients, respectively. Associated cardiovascular anomalies were present in fifteen patients. Twenty patients with definite symptoms underwent surgical treatment. The median interval between diagnosis and operation was 6 days. Four patients eventually died; three deaths were associated with complex heart diseases, and one had pulmonary artery sling with severe tracheal stenosis. Only the presence of a complex heart disease significantly influenced mortality (p=0.002).
  
  
  CONCLUSIONS
  Vascular rings include several types of anomalies, each with a different prognosis and symptoms. The presence of a complex heart disease was significantly associated with mortality. Early diagnosis and timely surgery in symptomatic patients are essential.
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Suh
authors.forename: Gi Beom
authors.initials: GB
authors.lastname: Kim
authors.forename: Bo Sang
authors.initials: BS
authors.lastname: Kwon
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Bae
authors.forename: Chung Il
authors.initials: CI
authors.lastname: Noh
authors.forename: Hong Gook
authors.initials: HG
authors.lastname: Lim
authors.forename: Woong Han
authors.initials: WH
authors.lastname: Kim
authors.forename: Jeong Ryul
authors.initials: JR
authors.lastname: Lee
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim