Vascular Ring Anomalies

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Issues

Vascular Ring Anomalies

 

Right Aortic Arch

Entrapment of the esophagus by a persistent right fourth aortic arch on the right and dorsally, the base of the heart and pulmonary artery ventrally, and ductus or ligamentum arteriosum on the left and dorsally.

Causes megaesophagus cranial to the obstruction at the base of the heart.

 

Double Aortic Arch

Entrapment of the esophagus by a functional aortic arch on the right, an atretic aortic arch on the left, the base of the heart and pulmonary artery ventrally, and ductus or ligamentum arteriosum on the left and dorsally.

Causes megaesophagus cranial to the obstruction at the base of the heart; also causes some tracheal compression.

 

SIGNALMENT

  • Dogs and cats
  • Seen most commonly in German shepherds, Irish setters, Great Dane, and Boston terriers.

 

SIGNS

  • Regurgitation of undigested solid food in animals < 6 months old.
  • Malnourishment in many animals.
  • Time between eating and regurgitation varies.
  • Signs of aspiration pneumonia (e.g., cough, tachypnea or dyspnea) in some animals.

 

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

  • Congenital megaesophagus
  • Stricture, diverticulum, or esophageal foreign body
  • Esophageal motility disorder in Shar-Peis
  • CBC/BIOCHEMISTRY/URINALYSIS
  • Results usually normal
  • High white blood cells in some animals with aspiration pneumonia

 

IMAGING

  • Thoracic radiography—shows food-filled cranial esophagus or signs of aspiration pneumonia in some animals.
  • Contrast esophagography—confirms megaesophagus extending to the heart base.
  • Fluoroscopy—may be used to differentiate esophageal motility disorders.
  • Angiography—may be needed to differentiate between specific vascular ring anomalies.

 

OTHER DIAGNOSTIC PROCEDURES

Esophagoscopy can be used to differentiate esophageal motility disorders.

 

TREATMENT

  • Surgical correction of the vascular entrapment is indicated—can be performed thoroscopically in some cases.
  • Medical management of concurrent aspiration pneumonia may be necessary.
  • Feeding procedures for megaesophagus may also be necessary for a prolonged period.
  • Supportive care with oxygen may be needed in animal with aspiration pneumonia.

 

MEDICATIONS

DRUG(S)

Broad-spectrum antibiotics, such as enrofloxacin (2.5 mg/kg q12h) and amoxicillin (10–15 mg/kg q12h) should be instituted in animals with aspiration pneumonia.

 

FOLLOW-UP

EXPECTED COURSE AND PROGNOSIS

Prognosis for resolution of the problem, even after surgery, is guarded although some can have resolution of clinical signs.

Complications of malnourishment and aspiration pneumonia are common and severe.

Esophageal function is often permanently compromised.

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