BRIEF COMMENTS
EXPERT: Prof. Grażyna Bochenek, MD, PhD
Affiliation: Department of Pulmonology, Jegiellonian University, Krakow, Poland
COMMENT
It is difficult to evaluate direct association between severity of asthma and coexisting vascular ring. There is a positive allergic history. Due to the esophagus compression, the patient has difficulties with swallowing. Chocking with food can increase bronchi reactivity. Currently pulmonologic management is being optimized.
EXPERT: Assoc. Prof. Jacek Kołcz, MD, PhD
Affiliation: Department of Pediatric Cardiac Surgery, Jagiellonian University Medical College, Krakow, Poland
COMMENT
Increasing difficulties with swallowing and chocking of the patient promotes surgical treatment. There is a real concern, that these symptoms will not resolve directly after the procedure. In the second place esophagus and trachea plasty may be considered.
EXPERT: Prof. Zbigniew Kordon, Md, PhD
Affiliation: Department of Pediatric Cardiology, Jagiellonian University Medical College, Krakow, Poland
COMMENT
Familiar occurrence of the vascular ring as in the presented case happens very rarely. Recurrent choking with food may increase bronchi reactivity and the surgery eliminating the ring can reduce not fully effective pharmacotherapy. In children difficulties with swallowing remain for some time after surgery, moreover tracheamalacia cannot be excluded. Despite these questions along with postponing the surgery the associated risk will increase.
EXPERT: Assoc. Prof. Bogusław Kapelak, MD, PhD
Affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
COMMENT
The risk of surgery is associated with thin esophagus wall and possible damage, technical difficulties in case of vascular calcifications and concern about postoperative ischemia of the limb. Regarding decreasing quality of life of the patient and lack of effective conservative treatment, it seems that at the moment potential benefits of the intervention outweigh the associated risk. The patient requires thorough diagnostic imaging and detailed information about the extent of surgery, realistic benefits, possible complications and further management.
CONCLUSIONS
1. The patient is qualified to surgery provided that she agrees for proposed treatment.
2. The patient requires comprehensive information about proposed technic of surgery, expected results and possible complications.
“Development of the European Network in Orphan Cardiovascular Diseases”
„Rozszerzenie Europejskiej Sieci Współpracy ds Sierocych Chorób Kardiologicznych”
