1. Vascular Rings 56.15 Amoreena Howell

2. 2 day old F Dyspnea and cough, inspiratory stridor Worse with feeding

3. MRA

4. click on image

5. Vascular Rings Complete vs. Partial Double Aortic arch most common (40%) –failure of regression of both the right and left fourth branchial arches Right aortic arch with left ligamentum arteriosum –highly associated with congenital heart defects (98% of cases), particularly TOF Anomalous left PA (vascular sling) –rare, the left PA arises from the right PA Barium Esophogram reveals indentations MRI for complete anatomy

6. Aortic Development

7. Mangement Medical if asymptomatic (careful feeding, soft foods, aggressive tx of pulm infections) Surgical division of ring if symptomatic

8. References Myung K. Park, Pediatric Cardiology for Practitioners, 4th ed., St. Louis, Mosby Inc., 2002, pp. 241-246. Townsend CM, Beauchamp ED, Evers BM, Mattox KL, Sabiston Textbook of Surgery, 17th ed., Philadephia, Elsevier, 2004, p. 1837 Collins-Nakai R, “How congenital heart disease originates in fetal life.” Cardiol Clin, 01-AUG-2002; 20(3): 367-83, v-vi