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    Vascular Ring Division: 2011

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    Redmond P. Burke MD
    Redmond Burke MD, Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital, describes our program's approach to patients with vascular ring.

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    Vascular Ring Division: 2011

    Uploaded by

    Redmond P. Burke MD
    201 views15 pages
    Redmond Burke MD, Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital, describes our program's approach to patients with vascular ring.

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    Redmond Burke MD, Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital, describes our program's approach to patients with vascular ring.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    201 views15 pages

    Vascular Ring Division: 2011

    Uploaded by

    Redmond P. Burke MD
    Redmond Burke MD, Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital, describes our program's approach to patients with vascular ring.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 15

    Reducing the Trauma of Vascular

    Ring Division

    Redmond P. Burke, M.D.


    Chief, Division of Cardiovascular
    Surgery
    The Congenital Heart Institute
    Miami Children’s Hospital
    Surgical History of Vascular Ring
    First surgical division by Dr Robert Gross
    At Boston Children’s Hospital in 1945

    First Video-assisted thoracoscopic


    vascular ring division by Burke at Boston Fig. 4. Pitx2c in remodeling the great vessels and outflow tract. (A) Remodeling
    of aortic arch arteries and derivation of mature aortic arch vessels (adapted

    Children’s Hospital in 1993, 48 years later


    from Moore, 1982). Cathy Walters
    E-mail: cathy@biologists.com
    Clinical Presentation may be variable:
    breathing problems, swallowing problems,
    both, or nothing.

    This child was diagnosed when he swallowed a coin.


    Barium Swallow

    Remains the “Gold Standard” for diagnostic tests.


    Surgical Approach: Thoracotomy vs Video
    Assisted Thoracoscopic Surgery (VATS)
    Our Surgical
    Approach:
    Reduce cumulative
    patient trauma
    with a video
    assisted
    thoracoscopic
    approach to avoid
    a large chest
    incision
    How we Definine The Perfect
    Approach for Vascular Ring
    Division
     No breast trauma
     No muscle trauma
     No nerve trauma
     Put the surgeon close to the lesion,
    allowing precise diagnosis, dissection,
    suturing, and vascular control
    Double Aortic Arch Dissection
    Completed Division

    Surgical note:
    We precisely
    cut the scar
    tissue on the
    surface of the
    esophagus
    Video of Vascular ring division:
    Right Aortic Arch, aberrant left subclavian,
    left ligamentum
    Surgical Techniques for Ring Sling
    Complex

    Surgical
    philosophy:
    Repair the trachea
    and the left
    pulmonary artery
    in the least
    traumatic way.
    Follow the LPA
    closely.
    Innominate Suspension: for
    patients with innominate artery
    compression of the trachea

    Surgical Options:
    Anterior tacking
    of the
    innominate
    artery to the
    sternum, or
    detachment and
    reimplantation of
    innominate
    artery
    Potential Surgical Complications
    after vascular ring division
     Recurrent or Phrenic Nerve injury
     Persistent vascular ring
     Caused by the surgeon missing one element of a double aortic
    arch
     Chylothorax:
     Caused by damage to the Thoracic duct.
     Hemorrhage
     Caused by injury to the aortic arch vessels.
     Persistent Symptoms
     It is fairly common for patients to have long term reactive
    airways (like asthma) even after ring division.
     We think this might justify earlier intervention on asymptomatic
    patients, to avoid this long term injury to the airway.
    Surgical Outcomes
     Miami Children’s Experience
     N= 24, DAA 14, RAA/ALSCA 8, PA sling 2
     Age Median 2 months, range 8 days to 42 years
     Weight Median 6.4 kg, range 2.5 kg to 78 kg
     Hospital Stay Median 5 days, range 1 to 27 days
     Mortality: zero
     Morbidity
     Major: none
     Minor: Atelectasis 3/24
    Thank You

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