It’s winter again, and the north wind brings not only snowflakes, but also plummeting temperatures. Pediatric clinics in major cities are crowded with poor little patients, especially those with respiratory illnesses: upper whistle infections, bronchitis, bronchopneumonia and so on. Bronchial asthma, a disease that causes many parents headaches, has reached its peak incidence in the year, but, parents, is your little one really suffering from bronchial asthma? Clinically, we diagnose bronchial asthma mainly from the clinical manifestations and physical examination, the presence of shortness of breath, whistling inspiratory difficulties, wheezing symptoms, physical examination of both lungs can be heard wheezing sound can be initially diagnosed, essentially due to the child’s allergic constitution and airway hyperresponsiveness, when encountering cold or allergens, pathogens infection stimulation of the airway repeated spasm, resulting in whistling inspiratory difficulties induced by the corresponding symptoms. However, in the field of congenital cardiovascular diseases, there is a fatal congenital malformation – congenital vascular ring with bronchial asthma has extremely similar clinical manifestations, such as missing the best time for surgery mortality rate of up to 90% or more, but it is difficult to accurately identify in primary hospitals and even tertiary hospitals in first-tier cities, because of its pathogenic characteristics, this small doctor has given him a bloody name: ” Death’s scythe”! Let’s take a look at this terrible disease together! Congenital vascular ring, in layman’s terms, is a congenital malformation of the development of the aorta or pulmonary artery resulting in its entanglement and extrusion of the adjacent trachea leading to tracheal stenosis and impaired ventilation. Vascular rings are divided into complete vascular rings and incomplete vascular rings. Complete vascular rings refer to the complete encirclement of the trachea after the formation of a vascular ring, which is commonly seen clinically as double aortic arches and right aortic arch ringing, while incomplete vascular rings are commonly seen as pulmonary artery slings. When the left pulmonary artery gradually develops and thickens, the pressure on the trachea will gradually increase, and eventually the trachea will be stuck dead, just like the scythe of death swinging down, and death will come with it. The clinical course of congenital vascular ring disease depends on the degree of tracheal compression. Most children are born without obvious manifestations, and as they get older, the main pulmonary artery gradually thickens and compression of the trachea becomes apparent. The main manifestations are wheezing, labored whistling, or recurrent lung infections, and are most likely to be misdiagnosed as infantile asthma at the first visit. The main reason for this is that the incidence of this disease is extremely low, the majority of pediatric internists are rarely exposed to it and are unfamiliar with this surgical disease, and children are often seen in the Department of Whistling Medicine for their first presentation, which, together with the low diagnostic accuracy of cardiac ultrasound, leads to missed diagnoses even in specialized pediatric medical centers in the north and south. If a congenital vascular ring is not treated in a timely manner, the most skilled physicians will be unable to help until the trachea is completely closed, resulting in severe whistling failure requiring the assistance of a whistling machine. In our experience, the mortality rate of babies who require preoperative assistance with a whistler is much higher than that of timely surgery. Even if they are lucky enough to survive after surgery, they require a very long recovery time. How can I recognize a congenital vascular ring in time? If your baby has recurrent wheezing, shortness of breath, poor pacification treatment, recurrent or progressive aggravation of symptoms within 6 months, you should find a local specialized cardiovascular center to carefully do a cardiac ultrasound or even cardiac CT for timely detection and timely treatment, with an overall surgical success rate of more than 95%. However, it should be noted that in children with pulmonary artery slings, in addition to vascular malformations, most of them also have congenital malformations in tracheal development. While normal tracheal cartilage formation resembles the letter C, the tracheal cartilage of babies in pulmonary artery slings resembles the letter O and is combined with severe stenosis. Because the O-shaped cartilage ring is closed and does not have any potential for deformation and expansion, the stenosis is slow to resolve. Even if the vascular compression is released, the stenosis of the trachea does not improve in the short term, and the symptoms of paroxysmal whistling difficulties persist for several months or even a year after surgery, and still require close attention, active anti-infection and symptomatic treatment.