Vascular ring operations are performed through a left third or fourth interspace thoracotomy and all anatomic structures are dissected. Angiography is rarely necessary to define vascular anatomy, although magnetic resonance imaging (MRI) or computerized tomography (CT) is used by many surgeons for this purpose. Vascular sling repair is also performed through a left thoracotomy, except in cases when associated intracardiac surgery is carried out. In this circumstance, a median sternotomy approach is used. Magnetic resonance imaging, CT, or angiography is helpful in defining this anomaly. An aortopexy is part of most vascular ring repairs because this pulls the pulsatile aorta away from the trachea. The aorta may continue to obstruct the trachea if left in its original position even after division of the ring.
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