Anneaux vasculaires : Prise en charge des anneaux vasculaires en chirurgie cardiaque, évaluation à court et moyen terme

Details

Supervisors

Poncelet, Alain ; Carbonez, Karlien

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

enIntroduction: Vascular rings represent 1% of congenital cardiovascular abnormalities. They are of several types and may be accompanied by different symptoms (related to compression of the esophagus and trachea). The purpose of this retrospective study is to evaluate the management of vascular rings in pediatric cardiac surgery over the last 20 years at Cliniques universitaires Saint-Luc, we analyzed the different modes of clinical presentation, and the persistence of symptoms in the medium term. One of the main questions of this study is to define the place of surgery in asymptomatic patients. Method: Initially, we collected data from patients treated at the CUSL through their medical files. Then we selected the patients eligible for this study (no other heavy cardiovascular abnormalities, usable data) and send a questionnaire to the referring pediatric cardiologist or the treating physician when we no longer had follow-up Results: Our cohort has 85 patients, 67 of whom were symptomatic (78%). The most common symptoms were recurrent lower respiratory tract infections (41.2%), dyspnea (30.6%), gastroesophageal reflux (35.3%) and dysphagia (25.9%). The most used additional tests in the assessment were cardiac ultrasound, barium esophagus (OED), and thoracic Angio scanner. 79 of our patients were operated on (93%), the median age was 2 years and 5 months. 91% were treated by post-thoracotomy, 17% (14 patients) had minor complications (resolved before the end of the stay), and mortality was 0%. 50% of patients had a hospitalization time equal to or less than 7 days. Patients with pulmonary slings were operated significantly younger than others and had a longer intubation time (3 days vs less than 1 day). At the last follow-up, 23% of patients still had residual symptoms. Conclusion: The majority of patients were in fact symptomatic, so the CUSL decision algorithm is not very different from other institutions. Some subtypes of vascular rings predispose to a rather acute symptomatology (double aortic arcs, pulmonary slings, and tracheal compression syndromes) that leads to rapid management during an urgent hospitalization. Finally, surgery in asymptomatic patients resulted in very little hospital morbidity.