Video-assisted thoracoscopic vascular ring division in infants and children

Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.

OBJECTIVES. This study evaluated our early experience with video-assisted thoracoscopic vascular ring division and compared this approach with division by means of a conventional open thoracotomy. BACKGROUND. Video-assisted thoracoscopic techniques reduce surgical trauma and have been applied to several adult thoracic procedures; however, pediatric applications have been limited. We developed instruments and techniques for video-assisted thoracoscopic vascular ring division in the pediatric population. METHODS. We compared patient characteristics, operative results and postoperative hospital courses of all patients undergoing vascular ring division by a video-assisted approach with a historical control group of all patients undergoing division by an open thoracotomy between January 1991 and December 1992. RESULTS. Eight patients (median age 5 months, range 40 days to 5.5 years; median weight 6.2 kg, range 1.8 to 17.1) underwent video-assisted thoracoscopic vascular ring division. Four had a double aortic arch with an atretic left arch and a left ligamentum, and four had a right aortic arch with aberrant left subclavian artery and a left ligamentum. All eight had successful ring division with symptomatic relief and no mortality. A limited thoracotomy was performed in three patients to divide patent vascular structures, and the hospital period was prolonged in one because of chylothorax. These eight patients were compared with a historical cohort of eight pediatric patients having vascular ring division performed by a conventional thoracotomy. The two groups did not differ in age, weight, intensive care unit or postoperative hospital stay, duration of intubation or thoracostomy tube or hospital charges. Total operating room time was longer for the group undergoing video-assisted operation. CONCLUSIONS. Early results for video-assisted thoracoscopic vascular ring division are comparable to those of the conventional surgical approach. With further refinement in technique and instrumentation, video-assisted surgical intervention may become a viable alternative to open thoracotomy for management of the symptomatic vascular ring.

This article has been cited by other articles:

				G. Shanmugam and J. Pollock Adult Dysphagia Associated with Type B Double Aortic Arch Asian Cardiovasc Thorac Ann, June 1, 2006; 14(3): e45 - e47. [Abstract] [Full Text] [PDF]

				G. Shanmugam, K. Macarthur, and J. Pollock Surgical Repair of Double Aortic Arch: 16-year Experience Asian Cardiovasc Thorac Ann, March 1, 2005; 13(1): 4 - 10. [Abstract] [Full Text] [PDF]

				T. Mihaljevic, J. W. Cannon, and P. J. del Nido Robotically assisted division of a vascular ring in children J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1163 - 1164. [Full Text] [PDF]

				R. K. Woods, R. J. Sharp, G. W. Holcomb III, C. L. Snyder, G. K. Lofland, K. W. Ashcraft, and T. M. Holder Vascular anomalies and tracheoesophageal compression: a single institution's 25-year experience Ann. Thorac. Surg., August 1, 2001; 72(2): 434 - 438. [Abstract] [Full Text] [PDF]

				K. Miyaji, R. L. Hannan, J. W. Ojito, J. A. White, and R. P. Burke Minimally invasive resection of congenital subaortic stenosis Ann. Thorac. Surg., April 1, 2000; 69(4): 1273 - 1275. [Abstract] [Full Text] [PDF]

				O. Reuthebuch, M. Roth, W. Skwara, W.-P. Klovekorn, and E. P. Bauer Cardioscopy: potential applications and benefit in cardiac surgery Eur. J. Cardiothorac. Surg., June 1, 1999; 15(6): 824 - 829. [Abstract] [Full Text] [PDF]

				J. A. van Son, A. Diegeler, E. K. Sim, R. Autschbach, and F. W Mohr Minimally Invasive Technique for Closure of Atrial Septal Defect Asian Cardiovasc Thorac Ann, June 1, 1998; 6(2): 88 - 90. [Abstract] [Full Text] [PDF]

				E. P. Bauer, O. T. Reuthebuch, M. Roth, W. Skwara, and W.-P. Klovekorn Video-Assisted Resection of Hypertrophied and Fibrous Intraventricular Tissue Ann. Thorac. Surg., April 1, 1997; 63(4): 1180 - 1182. [Abstract] [Full Text]

				J. H. Stevens, T. A. Burdon, W. S. Peters, L. C. Siegel, M. F. Pompili, M. A. Vierra, F. G. St. Goar, G. H. Ribakove, R. S. Mitchell, and B. A. Reitz PORT-ACCESS CORONARY ARTERY BYPASS GRAFTING: A PROPOSED SURGICAL METHOD J. Thorac. Cardiovasc. Surg., March 1, 1996; 111(3): 567 - 573. [Abstract] [Full Text]