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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016
36
AFRICA
structures constricting the trachea and oesophagus. In double
aortic arch, the non-dominant aortic arch (which may be
patent or atretic) and the ligamentum arteriosum are divided.
In the right aortic arch, aberrant left subclavian artery and
left ligamentum arteriosum variant, the ligamentum alone is
divided. Occasionally, a Kommerell diverticulum at the base
of the aberrant subclavian artery requires excision in the
primary operation, in order to avoid aneurysmal dilatation and
recurrence of symptoms.
2
Right thoracotomy is indicated in the unusual situation
when a left aortic arch, aberrant right subclavian artery, right
descending aorta and right ductus arteriosus is present.
4,5
Median
sternotomy is generally reserved for the correction of associated
intracardiac anomalies, and the repair of pulmonary artery slings
with or without sliding tracheoplasty. Following vascular ring
division, there is usually an improvement in clinical symptoms
over the ensuing weeks to months. No further imaging is
indicated in asymptomatic patients following surgery.
Conclusions
The diagnostic imaging algorithm for vascular rings has evolved
in tandem with the development of advanced non-invasive
imaging modalities such as CTA or MRI, which have become
the standard imaging techniques used to confirm the diagnosis
and guide surgical management. The choice between CTA and
MRI or vice versa remains an institutional preference, and
is usually based on logistic issues such as accessibility to the
imaging modality, the expertise required to undertake the study
and the preference of the radiologist and surgeon interpreting
the images. In our practice, CTA is the preferred cross-sectional
imaging modality and provides excellent correlation with intra-
operative findings.
This study was approved by the Biomedical Research Ethic Committee of
the University of KwaZulu-Natal (BE143/13). The authors acknowledge the
assistance of Dr JM Kalideen for his expert interpretation and independent
review of the imaging. We have no conflicts of interest or funding declara-
tions.
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