Early outcomes of surgical repair of vascular rings in infants and young children: a retrospective cohort study

Introduction: Vascular compression of the tracheobronchial tree (TBT) and esophagus occurs in congenital anomalies of the aortic arch, its branches, and the pulmonary arteries.Although the vast majority of patients with this condition are symptomatic, vascular compression is often not diagnosed promptly. The clinical presentation results from compression of the trachea and/or esophagus; therefore, the predominant manifestations are dyspnea (stridor, cough, and shortness of breath) and/or dysphagia (choking, difficulty swallowing, and regurgitation). Diagnostic approaches and methods of surgical treatment remain clinically relevant. The timing of and indications for surgical correction remain controversial, and outcome data are limited to a small number of publications. Objective: To evaluate the effect of surgical treatment of vascular rings on symptom resolution during the early postoperative period in infants and young children; to define indications for surgical treatment; to report the frequency of aortopexy used to preventresidual symptoms according to vascular ring anatomy; and to assess the incidence of chylothorax and its association with the anatomical type of vascular ring. Methods: This retrospective, nonrandomized cohort study included 58 pediatric patients who underwent surgery for an isolated congenital vascular ring causing compression ofthe TBT and esophagus at a single center between January 2018 and July 2024. Patients were divided into four groups according to vascular ring anatomy: double aortic arch (n = 16; 27.6%), right aortic arch with a left ligamentum arteriosum (n = 34; 58.6%), left aortic arch with a right ligamentum arteriosum (n = 4; 6.9%), and pulmonary artery sling (n = 4; 6.9%). All patients underwent contrast-enhanced multidetector computed tomography for diagnostic confirmation and surgical planning. Early symptom resolution,technical aspects of surgical correction, postoperative length of stay, and postoperative complications were assessed. Results: The median age at surgery was 7 months (Q1–Q3, 4–25 months). Preoperative symptoms (dyspnea and/or dysphagia) were present in 84.5% of patients. There were no statistically significant between-group differences in anthropometric characteristics, age, or symptom status (p > 0.05). Complete symptom resolution by hospital discharge was achieved in 83.7% of symptomatic patients. Length of hospital stay differed significantly among the groups (p = 0.028), with the highest median in the pulmonary artery sling group (18 hospital days), owing to the need for cardiopulmonary bypass and a more severe baseline condition. Chylothorax was the most common complication, occurring in 13 patients (22.4%) and most frequently in those with a double aortic arch (43.8%). Aortopexy was performed most frequently in patients with a right aortic arch and left ligamentum arteriosum(70.6%; p = 0.001). There were no deaths. Conclusion: Surgical correction of vascular rings in infants and young children was highly effective in the early postoperative period, with complete symptom resolution in 83.7% of symptomatic patients and no mortality. These findings support the safety of surgery when combined with early diagnosis and a multidisciplinary approach. In our opinion, for a vascular ring formed by a right aortic arch and left ligamentum arteriosum, adding aortopexy to division of the ligamentum arteriosum may visibly eliminate residual esophageal compression.The long-term clinical benefit of this approach requires further evaluation. The principal clinical concern is the substantial incidence of postoperative chylothorax (22.4%), underscoring the need to improve surgical techniques and management protocols and to identify the underlying causes. Received 17 February 2026. Revised 20 May 2026. Accepted 23 June 2026. Informed consentThe patient’s official representative has provided informed consent for the use of the recordings for medical purposes. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest.Ethics approvalThis retrospective study was approved by the local ethics committee of Morozov Children’s City Clinical Hospital (Protocol No. 7 dated December 10, 2025). The study was conducted in accordance with the ethical principles of the World Medical AssociationDeclaration of Helsinki, as amended in October 2024. Consent was obtained from the patients’ legal representatives by telephone. Patient data wereanonymized before analysis.