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[Surgical repair for pulmonary artery sling on a 46-day-old infant]
J Horikoshi1, Y Takanashi, K Tokuhiro
1Department of Thoracic Cardiovascular Surgery, Toho University, School of Medicine, Tokyo, Japan.
Insights
This case report details the successful surgical repair of a pulmonary artery sling in a 46-day-old infant. The procedure corrected airway compression, leading to a positive recovery and improved pulmonary perfusion.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Pulmonary artery sling is a rare congenital anomaly where the left pulmonary artery arises from the right pulmonary artery and passes between the trachea and esophagus.
- This anomaly can cause significant tracheobronchial compression, leading to respiratory distress and potentially life-threatening complications in infants.
Observation:
- A 46-day-old female infant presented with dyspnea and right lung atelectasis, requiring mechanical ventilation.
- Diagnostic imaging revealed a pulmonary artery sling compressing the trachea and right bronchus.
- The patient underwent surgical correction involving repositioning and reanastomosing the anomalous left pulmonary artery.
Findings:
- The infant was successfully weaned from the respirator and extubated on postoperative day 3.
- Postoperative imaging at one year showed a patent left pulmonary artery with slightly decreased left lung perfusion.
- The patient recovered uneventfully and was discharged on postoperative day 24.
Implications:
- Surgical repair of pulmonary artery sling, despite associated risks, can achieve favorable outcomes in selected pediatric cases.
- Early diagnosis and surgical intervention are crucial for managing this complex congenital heart defect.
- This case highlights the importance of advanced surgical techniques in treating rare pediatric cardiovascular anomalies.
Abstract:
Surgical repair on a 46-day-old girl with pulmonary artery sling is reported. She was suffered from dypnea and admitted to a hospital on 12 days after her birth. On chest roentgenogram atelectasis of right lung was found. She had been on respirator since 21 days after her birth. On bronchogram and pulmonary arteriogram, the trachea and right bronchus were compressed and shifted with the anomalous origin of left pulmonary artery which originated from the right pulmonary artery and passed between the trachea and esophagus. These results confirmed the diagnosis of pulmonary artery sling. Hence, she was referred to our hospital for surgical treatment. She underwent surgical repair on 46-day-old. In operation, we chose a mid-sternal splitting incision, and excised 5 mm of ductus arteriosus. Under extracorporeal circulation, the left pulmonary artery was amptated from the right pulmonary artery and pulled back to left side between the trachea and the esophagus. The left pulmonary artery was anastomosed to the main pulmonary artery at the anterior to the left bronchus. She weaned from respirator, and was extubated on the 3rd day after procedure. She recovered uneventfully in post-operative course. On the 24th day after operation she discharged from hospital. On pulmonary perfusion scanning and pulmonary arteriography performed one year after operation, the left pulmonary artery was patient with slightly decreased perfusion in the left lung. Surgical repair for pulmonary artery sling was recognized as high mortality because of frequently associated tracheobronchial anomalies. In the Japanese literature, only 4 patients survived surgically and lived in late stage.(ABSTRACT TRUNCATED AT 250 WORDS)