Vol. 30 No. 3 (2026)
CONGENITAL HEART DISEASES

Early outcomes of surgical repair of vascular rings in infants and young children: a retrospective cohort study

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  • Aleksey V. Bedin,
  • Yuriy N. Shamrin,
  • Mikhail A. Abramyan,
  • Evgeniya S. Korchkina,
  • Kseniya A. Khasanova,
  • Mariya M. Kurako,
  • Anastasiya Yu. Gotskina,
  • Vladimir P. Miroshnichenko,
  • Dmitriy Yu. Ovsyannikov
Aleksey V. Bedin
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation
Yuriy N. Shamrin
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation
Mikhail A. Abramyan
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation; Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russian Federation
Evgeniya S. Korchkina
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation
Kseniya A. Khasanova
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Mariya M. Kurako
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation;I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Anastasiya Yu. Gotskina
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation
Vladimir P. Miroshnichenko
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation; Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russian Federation
Dmitriy Yu. Ovsyannikov
Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2026-3-36-48

Published 2026-10-21

Keywords

  • дивертикул Коммереля; дыхательные расстройства; компрессия пищевода; компрессия трахеи; сосудистое кольцо; трахеобронхомаляция; хирургическое лечение сосудистых колец

How to Cite

Bedin, A. V., Shamrin, Y. N., Abramyan, M. A. ., Korchkina, E. S. K., Khasanova, K. A. K., Kurako, M. M. ., Gotskina, A. Y., Miroshnichenko, V. P. M., & Ovsyannikov, D. Y. O. (2026). Early outcomes of surgical repair of vascular rings in infants and young children: a retrospective cohort study. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 30(3), 36–48. https://doi.org/10.21688/1681-3472-2026-3-36-48

Copyright (c) 2026 Bedin et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Introduction: Vascular compression of the tracheobronchial tree (TBT) and esophagus occurs in congenital anomalies of the aortic arch, its branches, and the pulmonary arteries.
Although the vast majority of patients with this condition are symptomatic, vascular compression is often not diagnosed promptly. The clinical presentation results from compression of the trachea and/or esophagus; therefore, the predominant manifestations are dyspnea (stridor, cough, and shortness of breath) and/or dysphagia (choking, difficulty swallowing, and regurgitation). Diagnostic approaches and methods of surgical treatment remain clinically relevant. The timing of and indications for surgical correction remain controversial, and outcome data are limited to a small number of publications.

Objective: To evaluate the effect of surgical treatment of vascular rings on symptom resolution during the early postoperative period in infants and young children; to define indications for surgical treatment; to report the frequency of aortopexy used to prevent
residual symptoms according to vascular ring anatomy; and to assess the incidence of chylothorax and its association with the anatomical type of vascular ring.

Methods: This retrospective, nonrandomized cohort study included 58 pediatric patients who underwent surgery for an isolated congenital vascular ring causing compression of
the TBT and esophagus at a single center between January 2018 and July 2024. Patients were divided into four groups according to vascular ring anatomy: double aortic arch (n = 16; 27.6%), right aortic arch with a left ligamentum arteriosum (n = 34; 58.6%), left aortic arch with a right ligamentum arteriosum (n = 4; 6.9%), and pulmonary artery sling (n = 4; 6.9%). All patients underwent contrast-enhanced multidetector computed tomography for diagnostic confirmation and surgical planning. Early symptom resolution,
technical aspects of surgical correction, postoperative length of stay, and postoperative complications were assessed.

Results: The median age at surgery was 7 months (Q1–Q3, 4–25 months). Preoperative symptoms (dyspnea and/or dysphagia) were present in 84.5% of patients. There were no statistically significant between-group differences in anthropometric characteristics, age, or symptom status (p > 0.05). Complete symptom resolution by hospital discharge was achieved in 83.7% of symptomatic patients. Length of hospital stay differed significantly among the groups (p = 0.028), with the highest median in the pulmonary artery sling group (18 hospital days), owing to the need for cardiopulmonary bypass and a more severe baseline condition. Chylothorax was the most common complication, occurring in 13 patients (22.4%) and most frequently in those with a double aortic arch (43.8%). Aortopexy was performed most frequently in patients with a right aortic arch and left ligamentum arteriosum
(70.6%; p = 0.001). There were no deaths.

Conclusion: Surgical correction of vascular rings in infants and young children was highly effective in the early postoperative period, with complete symptom resolution in 83.7% of symptomatic patients and no mortality. These findings support the safety of surgery when combined with early diagnosis and a multidisciplinary approach. In our opinion, for a vascular ring formed by a right aortic arch and left ligamentum arteriosum, adding aortopexy to division of the ligamentum arteriosum may visibly eliminate residual esophageal compression.
The long-term clinical benefit of this approach requires further evaluation. The principal clinical concern is the substantial incidence of postoperative chylothorax (22.4%), underscoring the need to improve surgical techniques and management protocols and to identify the underlying causes.

Received 17 February 2026. Revised 20 May 2026. Accepted 23 June 2026.

Informed consent
The patient’s official representative has provided informed consent for the use of the recordings for medical purposes.

Funding
The study did not have sponsorship.

Conflict of interest
The authors declare no conflict of interest.
Ethics approval
This retrospective study was approved by the local ethics committee of Morozov Children’s City Clinical Hospital (Protocol No. 7 dated December 10, 2025). The study was conducted in accordance with the ethical principles of the World Medical Association
Declaration of Helsinki, as amended in October 2024. Consent was obtained from the patients’ legal representatives by telephone. Patient data were
anonymized before analysis.

Contribution of the authors
Data collection and analysis: A.V. Bedin, Yu.N. Shamrin
Statistical analysis: A.V. Bedin
Drafting the article: A.V. Bedin, Yu.N. Shamrin, A.Yu. Gotskina, E.S. Korochkina
Critical revision of the article: M.M. Kurako, M.A. Abramyan, K.A. Khasanova
Final approval of the version to be published: all authors

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References

  1. Young A.A., Hornberger L.K., Haberer K., Fruitman D., Mills L., Noga M., Tham E., McBrien A. Prenatal Detection, Comorbidities, and Management of Vascular Rings. Am J Cardiol. 2019;123(10):1703-1708. PMID: 30876659. https://doi.org/10.1016/j.amjcard.2019.02.030
  2. Backer C.L., Mavroudis C. Vascular rings and pulmonary artery sling. In: Mavroudis C., Backer C.L., editors. Pediatric Cardiac Surgery. Chapter 13. P. 234-255. Philadelphia: Mosby; 2003. https://doi.org/10.1002/9781118320754.ch13
  3. Gross R.E. Surgical relief for tracheal obstruction from a vascular ring. N Engl J Med. 1945;233:586-590. PMID: 21003928. https://doi.org/10.1056/nejm194511152332003
  4. Backer C.L., Mongé M.C., Popescu A.R., Eltayeb O.M., Rastatter J.C., Rigsby C.K. Vascular rings. Semin Pediatr Surg. 2016;25(3):165-175. PMID: 27301603. https://doi.org/10.1053/j.sempedsurg.2016.02.009
  5. Bertolini A., Pelizza A., Panizzon G., Moretti R., Bava C.L., Calza G., Tacchino A. Vascular rings and slings. Diagnosis and surgical treatment of 49 patients. J Cardiovasc Surg (Torino). 1987;28(3):301-312. PMID: 3294850.
  6. Hanneman K., Newman B., Chan F. Congenital Variants and Anomalies of the Aortic Arch. Radiographics. 2017;37(1):32-51. PMID: 27860551. https://doi.org/10.1148/rg.2017160033
  7. Козлов Б.Н., Панфилов Д.С., Пряхин А.С., Саушкин В.В., Суходоло И.В., Дзюман А.Н., Гутор С.С., Шарыш Д.В., Шипулин В.М. Сосудистое кольцо как причина дыхательных расстройств у взрослой пациентки. Кардиология и сердечно-сосудистая хирургия. 2017;10(1):79-81. Kozlov B.N., Panfilov D.S., Pryakhin A.S., Saushkin V.V., Sukhodolo I.V., Dzyuman A.N., Gutor S.S., Sharysh D.V., Shipulin V.M. Vascular ring as a cause of respiratory disorders in adult patient. Russian Journal of Cardiology and Cardiovascular Surgery. 2017;10(1):79-81. (In Russ.) https://doi.org/10.17116/kardio201710179-81
  8. Loomba R.S. Natural History of Asymptomatic and Unrepaired Vascular Rings: Is Watchful Waiting a Viable Option? A New Case and Review of Previously Reported Cases. Children (Basel). 2016;3(4):44. PMID: 28009833; PMCID: PMC5184819. https://doi.org/10.3390/children3040044
  9. Muller C.O., Derycke L., Kheniche A., Garcia G., Bernard S., Teissier N., Bonnard A. Routine multi detector computed tomography evaluation of tracheal impairment compared to laryngo-tracheal endoscopy in children with vascular ring. Pediatr Surg Int. 2018;34(8):879-884. PMID: 29961107. https://doi.org/10.1007/s00383-018-4279-4
  10. François K., Panzer J., De Groote K., Vandekerckhove K., De Wolf D., De Wilde H., Marchau F., De Caluwe W., Benatar A., Bové T. Early and late outcomes after surgical management of congenital vascular rings. Eur J Pediatr. 2017;176(3):371-377. PMID: 28091779. https://doi.org/10.1007/s00431-017-2850-y
  11. Callahan C.P., Merritt T.C., Canter M.W., Eghtesady P., Manning P.B., Abarbanell A.M. Symptom persistence after vascular ring repair in children. J Pediatr Surg. 2020;55(11):2317-2321. PMID: 32005503. https://doi.org/10.1016/j.jpedsurg.2019.12.022
  12. Backer C.L., Mavroudis C., Dunham M.E., Holinger L.D. Pulmonary artery sling: results with median sternotomy, cardiopulmonary bypass, and reimplantation. Ann Thorac Surg. 1999;67(6):1738-1744. discussion 1744-1745. PMID: 10391284. https://doi.org/10.1016/s0003-4975(99)00364-1
  13. Oakley C., Hurn A., Suckling C., Moriarty G., Simpson J.M., Turcu S., Heraghty J., Zidere V., Nyman A., Vigneswaran T.V. Impact on the trachea in children with prenatally diagnosed vascular ring formed by a right aortic arch. Pediatr Pulmonol. 2023;58(8):2275-2282. PMID: 37212498. https://doi.org/10.1002/ppul.26463
  14. Naimo P.S., Fricke T.A., Donald J.S., Sawan E., d’Udekem Y., Brizard C.P., Konstantinov I.E. Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution. Interact Cardiovasc Thorac Surg. 2017;24(2):234-239. PMID: 27798062. https://doi.org/10.1093/icvts/ivw344
  15. Evans W.N., Acherman R.J., Ciccolo M.L., Carrillo S.A., Mayman G.A., Luna C.F., Rollins R.C., Castillo W.J., Restrepo H. Vascular Ring Diagnosis and Management: Notable Trends Over 25 Years. World J Pediatr Congenit Heart Surg. 2016;7(6):717-720. PMID: 27834764. https://doi.org/10.1177/2150135116661279
  16. Vigneswaran T.V., Kapravelou E., Bell A.J., Nyman A., Pushparajah K., Simpson J.M., Durward A., Zidere V. Correlation of Symptoms with Bronchoscopic Findings in Children with a Prenatal Diagnosis of a Right Aortic Arch and Left Arterial Duct. Pediatr Cardiol. 2018;39(4):665-673. PMID: 29307026. https://doi.org/10.1007/s00246-017-1804-5
  17. Backer C.L., Russell H.M., Kaushal S., Rastatter J.C., Rigsby C.K., Holinger L.D. Pulmonary artery sling: current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2012;143(1):144-151. PMID: 22050985. https://doi.org/10.1016/j.jtcvs.2011.09.038
  18. Sahu A., Moe T.G. Identification and Management of Vascular Rings and Slings. JACC Case Rep. 2024;29(8):102316. PMID: 38774803; PMCID: PMC11103602. https://doi.org/10.1016/j.jaccas.2024.102316
  19. Perkins A.A., Tomescu A.L., Knott-Craig C.J., Boston U., Spentzas T., Ramakrishnan K.V. Aortopexy With Plication of Kommerell Diverticulum Is an Effective Alternative to Diverticulum Resection and Reimplantation of the Aberrant Left Subclavian Artery for Surgical Management of Vascular Rings in Children. World J Pediatr Congenit Heart Surg. 2025;16(4):446-449. PMID: 40208045; PMCID: PMC12146880. https://doi.org/10.1177/21501351251329912
  20. Backer C.L., Hillman N., Mavroudis C., Holinger L.D. Resection of Kommerell’s diverticulum and left subclavian artery transfer for recurrent symptoms after vascular ring division. Eur J Cardiothorac Surg. 2002;22(1):64-69. PMID: 12103375. https://doi.org/10.1016/s1010-7940(02)00213-0
  21. Luciano D., Mitchell J., Fraisse A., Lepidi H., Kreitmann B., Ovaert C. Kommerell Diverticulum Should Be Removed in Children With Vascular Ring and Aberrant Left Subclavian Artery. Ann Thorac Surg. 2015;100(6):2293-2297. PMID: 26428693. https://doi.org/10.1016/j.athoracsur.2015.06.093
  22. Егунов О.А., Подоксенов А.Ю., Лежнев А.А., Янулевич О.С., Ершова Н.В., Кривощеков Е.В. Лечение хилоторакса после билатерального двунаправленного кавопульмонального анастомоза. Хирургия. Журнал им. Н.И. Пирогова. 2018;(1):68-70. Egunov O.A., Podoksenov A.Yu., Lezhnev A.A., Yanulevich O.S., Ershova N.V., Krivoshchekov E.V. Chylothorax management after bilateral bi-directional cavopulmonary anastomosis. Pirogov Russian Journal of Surgery. 2018;(1):68-70. (In Russ.) https://doi.org/10.17116/hirurgia2018168-70
  23. Schwartz S.P., Winder M.M., Bautista A.N., Fundora M.P., Calamaro J., Puente B.R.N., Plummer S.T., Greiten L.E., Bertrandt R.A., Sznycer-Taub N.R., Matiasek M.J., Norbisrath K.S., Milroy R., Lay A., Reeder R.W., Furlong-Dillard J.M., Prodhan P., Bailly D.K. Management Options for Chylothorax After Vascular Ring Repair: Retrospective, Multicenter Cohort in the United States, 2021-2023. Pediatr Crit Care Med. 2026;27(1):42-51. PMID: 41196121. https://doi.org/10.1097/PCC.0000000000003855