Vascular rings and slings: A 20 - year experience

Vascular rings and slings are rare congenital anomalies that often result in obstructive respiratory or esophageal symptoms during early childhood. The authors report on 23 patients with vascular rings or slings that were surgically repaired during between 1978 and 1998. All surgical procedures were performed by a single pediatric surgeon (RA) and all patients were managed on the pediatric surgical service. Sixty-seven percent of the children in this series had a double aortic arch. The clinical features of these children are presented and compared to those of the largest reported series in the literature. The embryologic basis, pathologic findings, and a strategy for surgical management of the most common vascular rings and slings are reviewed.
INTRODUCTION
Vascular rings and slings are a reasonably rare group of developmental anomalies that were described by D r s. R o b e r t G r o s s (1) and W i l l i s P o t t s (2) over a ten year period at midcentury. Many variations on the original descriptions have been reported over the last fifty years; but as more information has become available, it has been possible to separate them into two large groups (rings or slings) each having two major subdivisions. The purpose of this report is to describe a personal experience with these lesions over a 20-year period at 3 institutions and to review the relevant clinical and pathological findings associated with vascular rings and slings.
MATERIALS AND METHODS
The medical records of all patients with vascular rings or slings managed and treated by a single pediatric surgeon (RA) at three institutions (Oschner Clinic, Wyler Children<@146>s Hospital, Children<@146>s Memorial Hospital) between 1978. and 1998. were reviewed. All patients were managed on the pediatric surgical service. The pertinent clinical, radiographic and pathological findings associated with each case were reviewed. This limited series is compared to all children undergoing surgical repair of vascular rings or slings at the Children<@146>s Memorial Hospital, which holds the largest reported single-institution experience. A simple classification system and the embryological basis for these anomalies are presented. The authors<@146> strategy for surgical management of these patients is also described.