Vascular Ring Diagnosis and Management: Notable Trends Over 25 Years.
Vascular rings (VRs) are recognized as uncommon but not rare cardiovascular malformations.



We analyzed data from all patients born in Southern Nevada, who underwent diagnosis and management of VR from 1990 to 2015, RESULTS: From 1990 to 2015, a total of 92 patients were diagnosed prenatally and postnatally. Of the 92 patients, 73 (79%) had right aortic arch and aberrant left subclavian artery (RAA-ALS) with a left ductus arteriosus or ligamentum, 17 (19%) had a double aortic arch (DAA), and 2 (2%) had a pulmonary artery sling. Of the 92 patients, 75 had an isolated VR and 17 VR had significant additional congenital heart disease (CHD). Of the 75 patients with an isolated VR, 52 underwent surgical repair, and the most common surgical diagnosis was DAA in 6 (66%) of 9 for the period 1990 to 2005 versus less common in 9 (21%) of 43 during the period 2006 to 2015, P < .05. The isolated VR repair age significantly negatively correlated with increasing time from 1990 to 2015, R = -0.7 (P < .0001). Of the 75 isolated VR, 23 remain asymptomatic. The 17 VR with CHD were treated during infant palliation or intracardiac repair. Of the total 92 VR, 60 were born after a 2004 community introduction of the three-vessel fetal echocardiography view, from then the prenatal-detection rate has significantly increased-2004 to 2006, 0 (0%) of 9; 2007 to 2009, 1 (9%) of 11; 2010 to 2012, 11 (55%) of 20; and 2013 to 1015, 14 (70%) of 20 (P < .0001).



Over 25 years in Southern Nevada, VR prenatal diagnosis has increased, isolated VR age at surgery has decreased, and the percentage of those with RAA-ALS has increased.
Children's Heart Center Nevada, Las Vegas, NV, USA wnevans50@aol.com.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
William N
WN
Evans
Children's Heart Center Nevada, Las Vegas, NV, USA.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
Ruben J
RJ
Acherman
Children's Heart Center Nevada, Las Vegas, NV, USA.|Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV, USA.
Michael L
ML
Ciccolo
Children's Heart Center Nevada, Las Vegas, NV, USA.|Department of Surgery, University of Nevada School of Medicine, Las Vegas, NV, USA.
Sergio A
SA
Carrillo
Children's Heart Center Nevada, Las Vegas, NV, USA.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
Gary A
GA
Mayman
Children's Heart Center Nevada, Las Vegas, NV, USA.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
Carlos F
CF
Luna
Children's Heart Center Nevada, Las Vegas, NV, USA.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
Robert C
RC
Rollins
Children's Heart Center Nevada, Las Vegas, NV, USA.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
William J
WJ
Castillo
Children's Heart Center Nevada, Las Vegas, NV, USA.|Division of Pediatric Cardiology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA.
Humberto
H
Restrepo
D000015:Abnormalities, Multiple / Q000175:diagnosis* / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D004452:Echocardiography; D005260:Female; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D054079:Vascular Malformations / Q000175:diagnosis* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*
22-deletion syndrome; dysmorphic syndrome; prenatal detection; vascular ring