The Natural and Unnatural History of Congenital Aortic Arch Abnormalities Evaluated in an Adult Survival Cohort
Background: This study describes the different types of congenital vascular rings according to their anatomy, symptoms, and age at clinical onset and reports the surgical outcomes. Methods: A retrospective observational database study was conducted, reviewing the medical charts of 69 adult survivors with a history of a vascular ring, identified from the Dutch Congenital Cor vitia database. Results: Median age at presentation was 8.5 years (0-53.0 years). Thirty patients (43.5%) had a “left aortic arch with aberrant right subclavian artery,” 21 patients (30.4%) a “double aortic arch,” and 16 patients (23.2%) a “right aortic arch with aberrant left subclavian artery.” The main symptomatology at presentation comprised respiratory symptoms (82.9%). Almost three-quarters of patients were also diagnosed with asthma/bronchial hyperreactivity. Patients with a double aortic arch had more symptoms than patients with a left aortic arch with aberrant right subclavian artery and right aortic arch with aberrant left subclavian artery (P < 0.001), requiring surgery most often (P < 0.001). In patients with childhood onset of symptoms, preoperative spirometry (ie, peak expiratory flows) was more often abnormal as compared with adult patients (P ¼ 0.007). Surgery was performed in 42.0% of all patients at a median age of 17 years (0-63.0 years). Twenty-four (92.3%) of the operated patients showed improvement or complete relief of symptoms shortly after surgery. Of 26 asymptomatic nonoperated patients, 3 patients (11.5%) eventually developed symptoms. Conclusions: The low incidence of vascular rings, their anatomic heterogeneity, and a wide range of common symptoms often lead to misdiagnosis. Clinical awareness is warranted as a large subset of patients could benefit from surgery, even at an adult age.
|Persistent URL||dx.doi.org/10.1016/j.cjca.2018.12.004, hdl.handle.net/1765/116199|
|Journal||Canadian Journal of Cardiology|
Lodeweges, J.E., Dikkers, F.G, Mulder, B.J.M, Roos-Hesselink, J.W, Vliegen, H.W, van Dijk, A.P.J, … van Melle, J.P. (2019). The Natural and Unnatural History of Congenital Aortic Arch Abnormalities Evaluated in an Adult Survival Cohort. Canadian Journal of Cardiology, 35(4), 438–445. doi:10.1016/j.cjca.2018.12.004