Which of the following is an incomplete ring?
A. Double aortic arch, right dominant
B. Right arch with retroesophageal left subclavian artery
C. Right arch with mirror imaging branching
D. Double aortic arch, left dominant
E. Left arch with aberrant right subclavian artery
Answer: E. A left aortic arch with an aberrant right subclavian artery does not form a complete vascular ring. Double aortic arch forms a complete vascular ring, as does a right arch with a ligamentum arteriosum.
Which is correct regarding clinical presentation and diagnosis of vascular anomalies?
A. Neonates usually present with esophageal compression.
B. Patients with a double aortic arch present later in life.
C. Pulmonary artery sling usually presents during the first year of life.
D. The “four artery sign” is seen in innominate artery compression.
E. MRI easily detects the ligamentous segment.
Answer: C. Pulmonary artery sling usually presents during the first year of life. Neonates usually present with tracheal compression. Patients with double aortic arch usually present early in life and the “four artery sign” on CT is typical. MRI is unable to detect the ligamentous segment or nonpatent atretic arches.
Which is correct regarding operative technique for vascular anomalies?
A. The usual approach for double aortic arch repair is on the same side as the dominant arch.
B. A balanced double arch and left descending aorta should be approached through a right thoracotomy.
C. A left thoracotomy is preferred for the patient with situs inversus and a left arch with a right ligamentum.
D. For repair of a Kommerell diverticulum and vascular ring, the left subclavian artery should be transferred to the left carotid artery.
E. Circulatory arrest is the preferred strategy for pulmonary artery sling.
Answer: D. A Kommerell diverticulum and vascular ring is repaired by translocating the left subclavian artery to the left carotid artery. The usual approach for a double aortic arch is on the opposite side from the dominant arch. A balanced double arch and left descending aorta should be approached through a left thoracotomy. A right thoracotomy is preferred for the patient with situs inversus and a left arch with a right ligamentum. Circulatory arrest is typically not required for repair of pulmonary artery sling.
Which of the following would not be a suitable solution for a patient with tracheobronchial malacia?
Answer: D. Aortopexy, internal stenting, external splinting, and tracheostomy are all suitable options for the treatment of a patient with tracheobronchial malacia that is resistant to conservative therapy. Tracheal resection is not indicated.
Which of the following is true for outcomes after surgery for vascular anomalies?
A. Mean length of stay is 5 days.
B. Surgery for tracheobronchial malacia is required in 5 to 10 percent of patients.
C. Mortality for repair of pulmonary artery sling is zero.
D. 10 to 20 percent of patients with vascular rings have severe tracheobronchial malacia.
E. Video-assisted techniques are ideally suited for the patient with a double aortic arch.
Answer: C. Current surgical mortality for repair of pulmonary artery sling is zero. Mean length of stay is approximately 3 days, and surgery for tracheobronchial malacia is required in less than 5 percent of patients. Severe tracheobronchial malacia is present in 5 to 10 percent of vascular ring patients. Video-assisted techniques are best reserved for patients with nonpatent/atretic archs or ligamenta.