Pediatric Heart Expert Forum
echocardiogram to rule out vascular ring?
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echocardiogram to rule out vascular ring?

Hi, I posted a few months ago before my son had his follow up appointment with the cardiologist. So here's the story. I'll make it quick. My son had a heart murmur that turned out to be innocent, and the cardiologist told me that his heart was perfect. During the echo they incidentally found a right aortic arch. The cardiologist was unable to see if there was a vascular ring or not, so she told us to return for a follow up appointment to see if he had this vascular ring. He had his appointment about a month ago. They did another echocardiogram, and she said the branching is normal with no vascular ring. I understand that I am probably being over paranoid but I have read that an echocardiogram is not the best imaging modality to diagnose a vascular ring. I know that there is a rare type of ring with normal branching, so I'm just worried that maybe she wasn't able to see it on the echo? She said that she will never need to see my son again as there is no vascular ring.the internet has just kind of scared me by saying that sometimes an echo can miss a vascular ring. Can I rest assured that the cardiologist was able to fully exclude a vascular ring with an ecocardiogram alone?

Thank you so much in advance for your response.
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A right aortic arch is present in a small percentage of the normal general population, and they never know that they have it, because there is no vascular ring to cause narrowing of the trachea (airway tube).  This type of right aortic arch is called mirror image branching (which is what it sounds like your cardiologist has described),  In the absence of any airway symptoms, there is no reason to look futher with other imaging studies.  The most definitive imaging study for a vascular ring is an MRI.  But that is an expensive test and requires sedation.  It would be used in unclear cases, or in patients with symptoms.  Some patients are proven to have a vascular ring, but never have any intervention, because the ring is "loose" and does not cause any significant airway narrowing.  So I would say that you should discuss your concerns with the cardiologist, but if it is a mirror image right aortic arch, and your child has no airway symptoms, then I am not sure that there is anything else to be done here.
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