EP09.92: Prediction of symptoms and evaluation of surgical indications after birth based on tracheal morphology of double aortic arch

A double aortic arch-associated vascular ring develops immediately after birth, with severe respiratory symptoms, or in infancy, with breathing and swallowing difficulties. The number of cases diagnosed in fetuses has increased in recent years, it has become clear that many patients are asymptomatic. Therefore, it is necessary to re-examine the treatment strategy for double aortic arch-associated vascular rings. The aims are to clarify the prediction of symptoms and evaluation of surgical indications after birth based on the tracheal morphology of the double aortic arch. This study included 19 patients diagnosed with a double aortic arch and vascular ring that were managed perinatally at our hospital from 2013 to 2024. Medical information, including postnatal contrast-enhanced computed tomography (CT), was retrospectively obtained. Horizontal sections of contrast-enhanced CT images were used to measure the tracheal areas against the narrowest and reference areas of the trachea. The narrowest area was defined as the trachea surrounded by the vascular ring and was narrowly delineated, whereas the reference area was defined as the trachea at the level of the clavicle. Using these values, the tracheal area ratio (narrowest tracheal area/reference tracheal area) was calculated and compared between the S (symptomatic: wheezing and poor oxygenation after birth) and non-S (asymptomatic) groups. The 19 patients (11 male and eight female) enrolled in this study included four in the S group and 15 in the non-S group. All patients in group S underwent surgery during the neonatal period. The median tracheal area ratio of the S and non-S groups was 0.32 (0.21–0.44) and 0.61 (0.32–0.81), respectively. Four patients in the non-S group did not undergo surgery and are symptom-free. The tracheal area ratios of these four patients were >0.5. Some cases of double aortic arch/vascular ring do not require surgery, indicating that the tracheal area ratio of >0.5 may be a criterion for a non-operative policy.