血管环
正常心脏和出现血管环的心脏
正常心脏和出现血管环的心脏
血管环是一种主动脉弓的解剖结构畸形,表现为血管部分或全部环绕气管和食管。正常的心脏和正常的主动脉弓见左图。血管环(即双主动脉弓)示例见右图。
主动脉是从心脏发出的主要血管,主动脉弓出现畸形即为血管环。该畸形致使主动脉弓及其分支部分或完全环绕气管和/或食管。食管是从口腔一直延伸至胃部的管道。
虽然这些是出生时就存在的(先天性)缺陷,但症状可能在婴儿期或年龄更大时才出现。导致症状的原因是血管环的某一部分压迫气管和/或食管。
有些血管环患者没有症状,但血管环压迫气管和食管可能会引起呼吸和消化问题。呼吸道体征和症状可能包括:
消化道体征和症状可能包括:
血管环患者可能还有其他先天性心脏缺陷。
症状
Some people with a vascular ring don't have symptoms. Sometimes symptoms aren't noticed until later in life. If a vascular ring presses against the trachea and esophagus, it can lead to breathing and digestive problems.
Symptoms of a vascular ring may include:
- Frequent respiratory infections.
- Wheezing.
- Coughing.
- Trouble swallowing.
- Difficulty feeding.
- Vomiting.
Some people born with a vascular ring also may have other heart problems at birth. Specific symptoms depend on the type of heart problems present.
Types
诊断
为了诊断血管环并排除其他可能引起症状的状况,医生可能会检查孩子的体征和症状、进行体格检查,并安排以下检查:
治疗
通常需要手术来治疗压迫气管或食管的血管环,并避免并发症。外科医生将血管环分开,以释放压迫气管和食管的血管。该手术通常通过开放性手术进行,但在某些情况下,可以使用微创方法。
根据具体的畸形状况,可使用不同的手术方法。
患有血管环的儿童和成人可能需要终生护理,并需要专家定期进行复诊以监测状况。先天性心脏病专家以及接受过肺部状况培训(肺科医师)、消化系统状况培训(消化科医师)和耳鼻喉状况培训的医生等各类专家都可参与护理。
May 03, 2022
- Fulton DR, et al. Vascular rings and slings. https://www.uptodate.com/contents/search. Accessed Nov. 28, 2022.
- Yoshimura N, et al. Congenital vascular ring. Surgery Today. 2020; doi:10.1007/s00595-019-01907-5.
- Kliegman RM, et al., eds. Other congenital heart and vascular malformations. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Nov. 28, 2022.
- Adam A, et al., eds. The thoracic aorta: Diagnostic aspects. In: Grainger & Allison's Diagnostic Radiology. 7th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Nov. 28, 2022.
- Tests for lung disease. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/lung-tests#. Accessed Nov. 28, 2022.
- Kliegman RM, et al., eds. Respiratory distress. In: Nelson Pediatric Symptom-Based Diagnosis: Common Diseases and Their Mimics. 2nd ed. Elsevier; 2023. https://www.clinicalkey.com. Accessed Nov. 28, 2022.
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