Endoscopic division of the vascular rings in children

Abstract

Introduction. Congenital anomalies of the aortic arch such as a double aortic arch and a right-sided aortic arch can result in a severe respiratory failure, which requires emergency surgery. Modern equipment and accumulated experience make it possible to perform thoracoscopic surgery for this type of pathology. Materials & methods. A total of 16 children (age from 1 months to 17 years, weight from 3,3 to 64 kg) who underwent thoracoscopic division of vascular rings from 2008 to 2016 in Filatov Pediatric Clinical Hospital No.13 were included in the study. The timing of surgery depended on the clinical picture and the severity of the respiratory failure. There were two types of vascular rings: double aortic arch - 7 children (40%), right-sided aortic arch with Botallo’s duct - 9 children (70%). Results. Mean operating time was 57 minutes. The average length of stay was 10 days. There was no intraoperative complications. In early postoperative period there was bleeding in one child due to failure of clipping the the distal segment of the aortic arch which required thoracotomy. Postoperative chylothorax was observed in one child, which was treated conservatively. Conclusion. The latest advances in surgical methods allowed to make thoracoscopic division of vascular rings in infants and children the method of choice with detailed intraoperative visualisation of the anatomy of the defect and secure mobilization of large vessels. Thoracoscopic surgery for congenital anomalies of the aortic arch is feasible to improve the postoperative outcomes and reduce the time of hospitalization.