Recent Demographic Trends and Clinical Insights in Paediatric Vascular Rings and Slings: A Retrospective Case Series Analysis

Background: Vascular rings and slings are the most common aortic arch anomalies. The age of presentation and diagnosis is typically 0-6 months. Diagnostic methods have shifted with increasing preference for echocardiograms related to technique, quality, and understanding. Therefore, we aimed to examine the rising prevalence of vascular ring and sling diagnoses. Methods: Retrospective analysis (n = 115) was performed using electronic medical records at McMaster Children's Hospital from 2015 to 2021. Diagnostic modalities used in the diagnosis of vascular rings and slings include echocardiography, computed tomography scan, and magnetic resonance imaging. Routine use of a 3-vessel tracheal view was introduced in fetal echocardiography during the study period. Results: A total of 115 patients (male 48) were diagnosed and/or followed up with a vascular ring or sling during the study period. Eighteen patients were diagnosed with a vascular ring or sling before 2015, whereas 97 patients were diagnosed with a vascular ring or sling from 2015 to 2021. The majority of patients were asymptomatic (82.5%). The antenatal and postnatal median age of diagnosis was 24 weeks of gestation and 1 year, respectively. The median age of symptom onset was 4 months. Ninety-six percent of patients were diagnosed using an echocardiogram. Conclusions: Incidental diagnoses of fetal and paediatric vascular rings and slings have increased with the use of a routine 3-vessel tracheal view in fetal life, increasing diagnostic capabilities of echocardiograms, and improvements in our understanding. Clinicians must provide counselling and reassurance to families that intervention may not be necessary.