Vascular ring: tracheoesophageal compression associated with symmetrical double aortic arch.

A 4-year-old girl was referred to our pediatric cardiology department for investigation of tracheal and esophageal obstructive symptoms: inspiratory laryngeal stridor, frequent episodes of respiratory tract infection, and cough (all symptoms since birth) and difficulty swallowing semi-solid and solid foods (since the age of 1 year). During the physical examination, the child was of inadequate weight and stature by coeval standards. She had inspiratory laryngeal stridor and dyspnea without cyanosis. Extrinsic compression of the airway and digestive tract by a vascular ring was suspected. Echocardiography suggested the presence of a double aortic arch. Multislice computed tomography (MSCT) confirmed that diagnosis and showed, further, a symmetrical type of double aortic arch: the right carotid and left subclavian arteries arose from the right arch and the left subclavian and carotid arteries arose from the left arch, each separately (Fig. 1). The trachea and esophagus were surrounded by this vascular ring, and the resultant stenosis was apparent (Fig. 2). Fig. 1 Left: Multislice computed tomography (left superior anterior view) reveals double aortic arches that separate at the distal portion of the ascending aorta. The right subclavian artery and right common carotid artery originate separately from the ... Fig. 2 Left: Axial image of enhanced multislice computed tomography reveals that the trachea and esophagus are surrounded by a vascular ring formed by the double aortic arch and that the trachea and esophagus are compressed by the vascular ring. Right: ... A left posterolateral thoracotomy revealed compression of the trachea and the esophagus by a complete vascular ring. We divided the left aortic arch just distal to the origin of the left subclavian artery and also divided the ligamentum arteriosum, thus freeing the esophagus and trachea. The postoperative course was uneventful and brought relief from respiratory symptoms. One year after the surgical correction, the child was doing well.