The surgeon divides the ligamentum arteriosum so that it no longer constricts the trachea or esophagus. The surgeon will cut and stitch closed one of the arches (usually the left) so the aorta no longer encircles or puts pressure on the trachea or esophagus. In most cases, the surgeon makes an incision on the left side of the chest and goes between the ribs to access the area. Vascular rings require surgery (not open heart) if there are symptoms. The Cardiac Center team will explain your child’s condition in detail. The structure of the vascular ring and its relationship to the trachea and esophagus varies from child to child. The ligamentum arteriosum is a remnant of a blood vessel that exists normally in the fetus it runs between the aorta and the pulmonary artery, and in doing so completes the ring and also might constrict the trachea and/or esophagus. This abnormal branch passes behind the esophagus and gives off the vessel to the left arm (the left subclavian artery) and the ligamentum arteriosum. The aorta starts off to the right, instead of the left (as is normal), and gives off an abnormal branch from the descending aorta. Right aortic arch with left ligamentum arteriosum The two arches then come back together into one vessel (the descending aorta). The aorta starts normally at the heart as one large vessel, but then divides into two arches: one on each side of the trachea and esophagus. There are different types of vascular rings. Arteries that deliver blood to the abdomen, legs and other parts of the lower body branch off from the descending aorta. Arteries that deliver blood to the head, arms and other parts of the upper body branch off at the top of the arch. Normally, the aorta starts at the left ventricle of the heart as one large vessel: it arches up (the aortic arch) to the left of the trachea and then down (the descending aorta). The condition is called “vascular ring” because the aorta - or other, related arteries - encircles the trachea and esophagus. “Vascular” means relating to blood vessels (veins and arteries). This happens when certain parts of the aorta that normally disappear during fetal development persist abnormally. A vascular ring occurs when the aorta (the large artery that carries oxygenated blood out of the heart) or its branches form a complete ring around the trachea (the tube that carries air to the lungs) and the esophagus (the tube that carries food to the stomach).
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