title: Reoperation after vascular ring repair.
abstract: The majority of patients having surgical intervention for a vascular ring have resolution of their symptoms. However, 5% to 10% of these patients develop recurrent symptoms related either to airway or esophageal compression and may require reoperation. In our series of 300 patients with vascular rings, we performed a reoperation on 26 patients, not all of whom were originally operated on at our institution. The four primary indications for reoperation were Kommerell diverticulum (n = 18), circumflex aorta (n = 2), residual scarring (n = 2), and tracheobronchomalacia requiring aortopexy (n = 4). All patients undergoing reoperation have had preoperative evaluation with bronchoscopy and computed tomographic scanning (CT) with 3-dimensional reconstruction. Patients with dysphagia have had a barium esophagram and esophagoscopy. Patients with a Kommerell diverticulum have undergone resection of the diverticulum and transfer of the left subclavian artery to the left carotid artery. The aortic uncrossing procedure has been used in patients with a circumflex aorta. Aortopexy has been used to treat anterior compression of the trachea by the aorta. Results of these reinterventions have been successful in nearly all cases. Lessons learned from these reoperations can be applied to prevent the need for reoperation by properly selecting the correct initial operation. A dedicated team caring for these children consisting of medical imaging, otolaryngology, cardiovascular-thoracic surgery, and critical care is imperative.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: cbacker@luriechildrens.org.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Mongé
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Hyde M
authors.initials: HM
authors.lastname: Russell
authors.affiliation: Division of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago.
authors.forename: Andrada R
authors.initials: AR
authors.lastname: Popescu
authors.affiliation: Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Rastatter
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago.
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
mesh_terms: D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004240:Diverticulum / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D012086:Reoperation; D014057:Tomography, X-Ray Computed