Methods: Clinical databases were searched to identify cases of vascular rings from 1993-2011. MRI, chest X-ray, barium swallow, catheterization, ECHO and operative reports were analyzed for each subject.
Results: Sixty one subjects were identified with the referral diagnosis of a possible vascular ring. As the MRI results were concordant with the operative vascular findings in all subjects with an MRI, we considered a vascular ring to truly be present if either the MRI or operative report confirmed a ring. Twenty two of the 61 subjects had confirmed vascular rings. Median age of 15 (0.1-259) months and weight of 9.9 (2.6-76.8) kg. Mean (SD) tests per subject was 2.1 ± 1.0 and 0.63 ± 0.8, total and radiation, respectively. ECHO was performed in 17 and in 15/17 (88%) the diagnosis was concordant with either the MRI or operative report. Four subjects had MRI with 100% concordance with the operative findings. Two catheterization and 2 barium studies agreed with the operative findings, although the barium failed to completely define the vascular anatomy.
Conclusion: In patients with symptoms suspicious for a vascular ring, echocardiography appears to be a sensitive first line study. These data support a non-radiation approach of echocardiography and/or MRI for the diagnosis of vascular rings. Other radiation studies should be reserved for cases were additional data is critical for decision making.