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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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References

1. Glaevecke, D, Doehle, H. Über eine selltene angeborene Anomalie der Pulmonalarterie. Muchen Med Wochenschr 1897; 44: 950–953.Google Scholar
2. Gikonyo, BM, Jue, KL, Edwards, JE. Pulmonary vascular sling: reports of 7 cases and review of the literature. Pediatr Cardiol 1989; 10: 81–89.CrossRefGoogle Scholar
3. Potts, WJ, Holinger, PM, Rosenblum, AH. Anomalous left pulmonary artery causing obstruction to right main bronchus. JAMA 1954; 155: 1409–1411.CrossRefGoogle ScholarPubMed
4. Fiore, AC, Brown, JW, Weber, TR, Turrentine, MW. Surgical Treatment of Pulmonary Artery Sling and Tracheal Stenosis. Ann Thorac Surg 2005; 79: 38–46.CrossRefGoogle ScholarPubMed
5. Contro, S, Miller, RA, White, H, Potts, WJ. Bronchial obstruction due to pulmonary artery abnomalities. I. Vascular swing. Circulation 1958; 17: 418–423.CrossRefGoogle Scholar
6. Berdon, WE, Baker, DH, Wung, JT, et al. Complete cartilage – ring tracheal stenosis asociated with anomalus left pulmoary artery: the ring – sling complex. Radiology 1984; 152: 57–64.CrossRefGoogle Scholar
7. Chen, SJ, Lee, WJ, Lin, MT, et al. Left Pulmonary Artery Sling Complex: Computed Tomography and Hypothesis of Embryogensis. Ann Thorac Surg 2007; 84: 1645–1650.CrossRefGoogle Scholar
8. Hagl, S, Sebening, C, Springer, W, Loukanov, T. Modified sliding tracheal platy using the bridging bronchus for repair of long – segmental tracheal stenosis. Ann Thorac Surg 2008; 85: 1118–1120.CrossRefGoogle Scholar
9. Pawade, A, de Leval, MR, Ellitott, MJ, Stark, J. Pulmonary artery sling. Ann Thorac Surg 1992; 54: 967–970.CrossRefGoogle ScholarPubMed
10. Castaneda, AR, Jonas, RA, Mayer, JE Jr, Hanley, FL. Vascular rings, slings and trácela anomalies. In: Castaneda AR, Jonas RA, Mayer JE Jr, Hanley FL (eds). Cardiac Surgery of the neonate and infant. WB Saunders, Philadelphia, 1994, pp 397–408.Google Scholar
11. Backer, CL, Idriss, FS, Holinger, LD, Mavroudis, C. Pulmonary artery sling: results of surgical repair in infancy. J Thorac Cardiovasc Surg 1992; 103: 683–691.CrossRefGoogle ScholarPubMed
12. Loukanov, T, Gorenflo, M, Sebening, C, Springer, W, Eichhorn, J, Ulmer, H, Hagl, S. Surgical treatment of long-segment tracheal anomalies in infants and children. Thorac Cardiovasc Surg 2007; 55: 375–379.CrossRefGoogle ScholarPubMed
13. Tsang, V, Murday, A, Gillbe, C, Goldstraw, P. Slide tracheoplasty for congenital funnel-shaped tracheal stenosis. Ann Thorac Surg 1989; 48: 632–635.CrossRefGoogle ScholarPubMed
14. Backer, CL, Mavroudis, C, Rigsby, C, Holinger, L. Trends in vascular ring surgery. J Thorac Cardiovasc Surg 2005; 129: 1339–1347.CrossRefGoogle ScholarPubMed
15. Sebening, C, Jakob, H, Lange, R, et al. Vascular tracheobronchial compression syndromes. Experience in surgical treatment and literature review. Thorac Cardiovasc Surg 2000; 48: 164–174.CrossRefGoogle ScholarPubMed
16. Jonas, RA, Spevak, PJ, Mc Grill, T, Castaneda, AR. Pulmonary artery sling: primary repair by tracheal resection in infancy. J Thorac Cardiovasc Surg 1989; 97: 548–550.CrossRefGoogle ScholarPubMed