Vascular Rings

What are vascular rings?

Vascular rings are a birth defect in which abnormally positioned arteries surround the trachea (the breathing tube that carries air to and from the lungs) and the esophagus (the tube that carries food to the stomach).

Vascular rings can press on the trachea and esophagus. This can cause breathing and feeding problems. Children with this condition may have symptoms in infancy or early childhood. Some children require treatment, but some do not.

  • Before birth, it’s normal for babies to have some arches of tissue near their trachea and esophagus. As the baby develops, these arches should either turn into normal arteries or disappear. This results in a single aortic arch that bends toward the left. Rarely, some of these arches do not disappear and turn into vascular rings.

    Sometimes, the abnormal structures wrap all the way around the trachea and esophagus. Sometimes, they wrap partway around. This can still cause pressure and symptoms.

    There are several types of rings, named for where and how they formed. These are the most common types: 

    • Double aortic arch. In this type, the aorta divides into two arches, with one going around the left side of the trachea and esophagus and one going around the right side.
    • Right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum. In this type, the aorta bends toward the right instead of the left as it leaves the heart. A ligament connects the pulmonary artery and one of the arteries that branch off the aorta, trapping the trachea and esophagus inside. 

    Your doctor can explain the type your child has.

Vascular Rings at Seattle Children’s


  • Our Heart Center is the top-ranked cardiology and cardiac surgery program in the Northwest and among the best in the nation, according to U.S. News & World Report. With more than 40 pediatric cardiologists, we have experience diagnosing and treating every kind of heart problem.

    Our heart team has treated many children with vascular rings. We have extensive experience with all of the possible surgical treatments these patients may require.

    The Adult Congenital Heart Disease Program shared by Seattle Children’s and the University of Washington can help with care throughout your child’s life.

    Seattle Children’s has been treating children since 1907. Our team members are experts in their fields and in meeting the unique needs of children. For example, the doctors who give your child anesthesia (sedation) are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialistsknow how to help children understand their illnesses and treatments in ways that make sense for their age.

  • When you come to Seattle Children’s, a team of people will take care of your child. Along with your child’s heart doctor (cardiologist), you are connected with other providers, such as neonatologists, lung doctors (pulmonologists), nurses, child life specialists, social workers and others, if their expertise is needed.

    We work together to meet all of your child’s health needs and help your family through this experience. We’ll discuss treatments in ways you can understand and involve you in every decision.

    Read more about the supportive care we offer.

Symptoms of Vascular Rings

Most babies with vascular rings have symptoms from the pressure the rings put on their trachea and esophagus. Some children with vascular rings have no symptoms as babies. They may develop symptoms as they get older.

Pressure on the trachea can cause breathing problems, such as: 

  • Loud breathing (stridor) or working hard to breathe
  • Wheezing or high-pitched cough
  • Infections in the lungs (respiratory infections) or repeated pneumonia 

Breathing problems may get worse when a baby tries to feed or when an older child eats.

Pressure on the esophagus can cause feeding problems, such as: 

Diagnosing Vascular Rings

To diagnose this condition, your doctor will examine your child and use a stethoscope to listen to their heart.

The doctor will ask for details about any symptoms your child has, their health history and your family health history.

Your child will need tests that provide more information. These may include: 

  • Chest X-ray
  • CT (computed tomography) scan or MRI (magnetic resonance imaging) of the heart and blood vessels
  • Echocardiography
  • Angiography
  • Bronchoscopy (threading a camera down the throat to check the airways)
  • X-ray of the esophagus

Treating Vascular Rings

Children who have symptoms from vascular rings need surgery. During surgery, doctors cut the rings so they don’t press on the trachea or esophagus.

Usually, this surgery is done through a small incision in the chest. It is not a very invasive surgery.

Your child may need medicine to help with their symptoms until surgery can be done.

If your child has vascular rings but doesn’t have symptoms, your doctor will want to check your child on a regular basis to see whether any symptoms start to develop.

New treatments for vascular rings

Our heart team works closely with the general pediatric surgeons to treat vascular rings as noninvasively as possible. Recently, we have developed a team that can treat some cases of vascular rings with thoracoscopic surgery, using a small camera and microsurgical tools inserted into the chest through tiny holes. This may reduce the recovery time after surgery.

Helping Your Child Transition to Adult Care

To meet your child’s long-term healthcare needs, we have a special Adult Congenital Heart Disease Program to transition your child to adult care when they’re ready.

Contact Us 

Contact the Heart Center at 206-987-2515 to request an appointment, a second opinion or more information.

Providers, see how to refer a patient.