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Pneumonectomy for intractable left bronchial compression in d-transposition of the great arteries
Insights
Transposition of the great arteries (TGA) can cause airway compression. Pulmonary artery banding offered temporary relief, while pneumonectomy ultimately resolved persistent lung atelectasis in a TGA patient.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Transposition of the Great Arteries (TGA) can lead to tracheobronchial obstruction.
- Dilated pulmonary arteries, especially with large VSDs, increase compression risk.
Observation:
- A patient with TGA experienced left lung collapse post-atrial septectomy.
- Bronchoscopy confirmed extrinsic compression of the left main bronchus.
Findings:
- Pulmonary artery banding provided temporary relief from respiratory distress.
- Recurrent atelectasis after Mustard procedure necessitated further interventions.
- Pneumonectomy at age 9 resolved persistent tracheobronchial compression and atelectasis.
Implications:
- This case highlights a rare complication of TGA management.
- Surgical interventions, including pneumonectomy, may be required for severe airway compression.
- Long-term resolution of respiratory symptoms was achieved through aggressive surgical management.
Abstract:
In infants with transposition of the great arteries (TGA) tracheobronchial obstruction may occur as a result of compression by a dilated posterior pulmonary artery, especially if there is a large interventricular septal defect with its attendant large pulmonary blood flow and high pressure. Banding of the pulmonary artery may give temporary relief. A patient with TGA had collapse of the left lung at 2 months of age, following atrial septectomy. Bronchoscopy and bronchography revealed extrinsic compression of the left main bronchus. Banding of the pulmonary artery at 6 months of age relieved the respiratory distress. At 8 years of age atelectasis of the left lung recurred following a Mustard procedure. Two additional procedures were attempted to decrease the pressure of the pulmonary artery on the bronchus but these were unsuccessful. At age 9 years, pneumonectomy, her sixth thoracotomy, was performed as a final attempt to relieve the respiratory problem caused by persistent atelectasis. She is now 17 years of age and has remained asymptomatic during the last 8 years.