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The evolution of the pulmonary arterial sling syndrome, with particular reference to the need for reoperations because of untreated tracheal stenosis

Published online by Cambridge University Press:  07 August 2009

Tsvetomir S. Loukanov ,
Christian Sebening ,
Wolfgang Springer ,
Siegfried Hagl ,
Matthias Karck  and
Mathias Gorenflo
Tsvetomir S. Loukanov*
Affiliation:
Department of Cardiac Surgery, , University of Heidelberg, Heidelberg, Germany
Christian Sebening
Affiliation:
Department of Cardiac Surgery, , University of Heidelberg, Heidelberg, Germany
Wolfgang Springer
Affiliation:
Department of Pediatric Cardiology, University of Heidelberg, Heidelberg, Germany
Siegfried Hagl
Affiliation:
Department of Cardiac Surgery, , University of Heidelberg, Heidelberg, Germany
Matthias Karck
Affiliation:
Department of Cardiac Surgery, , University of Heidelberg, Heidelberg, Germany
Mathias Gorenflo
Affiliation:
Department of Pediatric Cardiology, University of Heidelberg, Heidelberg, Germany
*
Correspondence to: Dr med. Tsvetomir Loukanov, Department of Cardiac Surgery, University of Heidelberg, INF 110, 69120 Heideberg, Germany. Tel: +49 6221 5636274; Fax: +49 6221 565919; E-mail: tsvetomir.loukanov@med.uni-heidelberg.de
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Abstract

Background

We present a group of infants and children with pulmonary arterial sling and tracheal stenosis. In some of the patients, the anomalously located pulmonary artery had previously been reimplanted, but without simultaneous repair of the trachea.

Methods

From 1992 to 2007, we reimplanted the left pulmonary artery in 13 children with a pulmonary arterial sling. Their median age was 8 months, with a range from 1 to 72 months. We also performed tracheal resection with end-to-end anastomosis, or complex tracheal reconstructions. In 5 patients, the reoperation was indicated because of persistent tracheal stenosis not treated initially at first correction of the arterial sling. All patients presented with stridor and respiratory distress. Cardiac catheterization, bronchoscopy and multidetecting computer tomography angiography were performed in all cases prior to the operation. All operations were performed under cardiopulmonary bypass.

Results

There was no operative or late mortality. The patients were extubated under bronchoscopic control. The mean period of intubation was 18 plus or minus 8 days, and the average follow-up was 8 plus or minus 4 years. The patients showed no signs of tracheal re-stenosis clinically or on bronchoscopy. The group of the patients under reoperations, however, required longer periods of intubation and hospitalization.

Conclusion

Our experience demonstrates that, in patients with a pulmonary arterial sling, any associated tracheal stenosis should be explored at the initial operation, since decompression of the trachea by reimplanting the anomalously located pulmonary artery fails to provide relief. The funnel trachea, if present, undergoes progressive stenosis, and will require surgical repair. The use of cardiopulmonary bypass permitted extensive mobilization of the tracheobronchial tree, and allowed us to perform a tension-free anastomotic reconstruction of the trachea.

Keywords

Congenital cardiac surgerypig bronchustracheal surgery
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 5 , October 2009 , pp. 446 - 450
Copyright
Copyright © Cambridge University Press 2009

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