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Pulmonary artery sling
A Pawade1, M R de Leval, M J Elliott
1Hospital for Sick Children, London, England.
Insights
Surgical repair of pulmonary artery sling, sometimes with tracheal stenosis, yielded excellent outcomes. Most patients experienced symptom resolution and normal growth, demonstrating the effectiveness of surgical intervention.
Area of Science:
- Cardiovascular Surgery
- Pediatric Surgery
- Thoracic Surgery
Background:
- Pulmonary artery sling is a rare congenital anomaly where the left pulmonary artery arises anomalously from the right pulmonary artery.
- Associated tracheobronchial anomalies, such as complete cartilaginous rings (stovepipe trachea), can complicate surgical management.
- Surgical treatment aims to correct the vascular anomaly and address airway obstruction.
Purpose of the Study:
- To review the surgical outcomes of patients treated for pulmonary artery sling.
- To evaluate the efficacy of surgical techniques in isolated pulmonary artery sling and in cases with associated stovepipe trachea.
- To assess long-term results, including mortality, morbidity, and functional recovery.
Main Methods:
- Retrospective review of 18 patients who underwent surgical treatment for pulmonary artery sling since 1969.
- Surgical approach involved division and reimplantation of the left pulmonary artery for isolated sling.
- For patients with stovepipe trachea, tracheal resection and reanastomosis were performed with the pulmonary artery repositioning.
Main Results:
- No early deaths occurred; one late death was reported.
- Pulmonary artery anastomosis remained patent in all investigated patients.
- The majority of patients achieved symptom-free status with normal growth and chest radiographs; three had residual tracheobronchial issues.
Conclusions:
- Surgical correction of pulmonary artery sling is effective, with low mortality and good long-term outcomes.
- The described surgical techniques provide successful management for both isolated pulmonary artery sling and complex cases involving stovepipe trachea.
- Early surgical intervention leads to favorable functional recovery and normal development in most pediatric patients.
Abstract:
Eighteen patients who underwent surgical treatment of pulmonary artery sling at this institution since 1969 were reviewed. Four of them had associated tracheal stenoses produced by complete cartilaginous rings (stovepipe trachea). All patients underwent operation. The median age at operation was 180 days (range, 27 days to 54 months). In the 14 patients with isolated pulmonary sling, the operation consisted of division of left pulmonary artery and reimplantation into the main pulmonary artery anterior to the trachea. In the 4 patients with stovepipe trachea, the stenotic tracheal segment was resected on cardiopulmonary bypass and the left pulmonary artery was brought anterior to the trachea before the latter was reanastomosed to the main pulmonary artery. There were no early deaths. One patient died late. The pulmonary artery anastomosis was patent in all 14 patients investigated postoperatively. Three patients have residual tracheobronchial problems. One patient is mentally retarded and is institutionalized. All other patients are symptom-free and growing normally and have normal chest radiographs.