Surgical treatment of vascular rings in children: from early symptom relief to evidence-based individualized management

Introduction: Vascular rings are a clinically heterogeneous group of congenital vascular anomalies that compress the airways and esophagus. They are reported to account for 1.08–2.09% of all diagnosed congenital heart defects. Better diagnostic imaging has led to more asymptomatic cases being found. However, indications for preventive intervention, the optimal timing of repair and the extent of surgery needed are still debated. The study by Bedin et al. provides Russian data relevant to these questions. Objective: To discuss the early surgical outcomes of vascular ring repair reported by Bedin et al. in the context of current literature. The focus is on diagnostic assessment, choice of surgical strategy, postoperative complications and the limits of the available evidence. Results: Among 58 operated children, all symptoms had resolved by discharge in83.7% of patients who had symptoms before surgery, and there were no deaths. These findings show favorable early outcomes but do not establish whether early surgery is more effective than surveillance. Current literature stresses the need to distinguish fixed vascular compression from dynamic airway collapse. Data from 2025 support further study of Kommerell diverticulum plication and/or pexy but do not show that these techniques are equivalent to diverticulum resection. The incidence of chylothorax was 22.4% in the study by Bedin et al., compared with 13.2% in a 2026 multicenter study. This difference calls for analysis of patient populations, diagnostic criteria and surgical factors. Standardized stenosis measurement, swallowing assessment and the distinction between anatomical decompression and functional recovery also need attention. Conclusion: Surgical repair of vascular rings in infants and young children givesfavorable early outcomes. However, indications for intervention in asymptomatic patients, the optimal timing of surgery and the choice of additional surgical techniques need further evidence. Individualized treatment should take into account vascular anatomy, the severity of compression and how well the airways and esophagus function. Multicenter prospective studies with standardized assessment of long-term outcomes are needed to refine treatment strategy and prevent complications.