Aberrant left pulmonary artery with tracheal stenosis without vascular sling

1991 ◽  
Vol 12 (1) ◽  
pp. 44-45 ◽  
Author(s):  
Felipe Moreno ◽  
Luis Garcia-Guereta ◽  
Fernando Benito ◽  
Carlos Gamallo ◽  
F. Campo ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tracheal Stenosis ◽  
Left Pulmonary Artery ◽  
Vascular Sling

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

2009 ◽  
Vol 19 (5) ◽  
pp. 446-450 ◽  
Author(s):  
Tsvetomir S. Loukanov ◽  
Christian Sebening ◽  
Wolfgang Springer ◽  
Siegfried Hagl ◽  
Matthias Karck ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Pulmonary Artery ◽  
Tracheal Stenosis ◽  
Left Pulmonary Artery ◽  
Tracheobronchial Tree ◽  
Tracheal Resection ◽  
Computer Tomography Angiography ◽  
Pulmonary Arterial ◽  
The Mean

AbstractBackgroundWe 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.MethodsFrom 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.ResultsThere 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.ConclusionOur 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.

Single Stage Repair of Tetralogy of Fallot Associated With Left Pulmonary Artery Sling and Tracheal Stenosis

2013 ◽  
Vol 28 (5) ◽  
pp. 595-598 ◽  
Author(s):  
Ajeya Joshi ◽  
Saket Agarwal ◽  
Satish Kumar Aggarwal ◽  
Vishnu Datt ◽  
G. R. Sethi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Tracheal Stenosis ◽  
Left Pulmonary Artery ◽  
Single Stage ◽  
Pulmonary Artery Sling ◽  
Left Pulmonary Artery Sling

Bronchial Obstruction Due to Pulmonary Artery Anomalies. I. Vascular Sling

PEDIATRICS ◽  
1958 ◽  
Vol 22 (1) ◽  
pp. 48-48
Keyword(s):  
Pulmonary Artery ◽  
Clinical Symptoms ◽  
Early Recognition ◽  
Vascular Ring ◽  
Left Lung ◽  
Posterior Wall ◽  
Left Pulmonary Artery ◽  
Bronchial Obstruction ◽  
Vascular Sling ◽  
The Right

The authors report three cases of respiratory embarrassment in infants from compression of the right bronchus and trachea by a "vascular sling" formed by an aberrant left pulmonary artery coursing anterior to the right main-stem bronchus and posterior to the trachea. Five similar cases have been described in earlier literature. The embryologic origin of this anomaly appears to be a disturbed time-sequence in the growth and union of the left pulmonary artery and the left lung bud. The clinical symptoms are those of respiratory distress in the neonatal period produced by tracheobronchial compression, associated with obstructive emphysema of the right lung. Bronchoscopic examination reveals extrinsic pressure on the right bronchus and posterior wall of the trachea. The esophagram does not reveal any posterior indentation and is thereby helpful in distinguishing this entity from the more common "vascular ring" which is a systemic arterial malformation causing constriction of the trachea and esophagus. Early recognition of an anomalous left pulmonary artery is particularly important in view of the fact that the condition can be corrected surgically.

Aortotracheal Fistula after Slide Tracheoplasty in a Patient with Dextrocardia, Left Pulmonary Artery Sling and Tracheal Stenosis: A Case Report

2021 ◽  
Author(s):  
Yu-san Chien ◽  
Yen-Chun Chao ◽  
Kuo-Sheng Lee ◽  
Kung-hong Hsu
Keyword(s):  
Pulmonary Artery ◽  
Tracheal Stenosis ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Left Pulmonary Artery ◽  
Laser Vaporization ◽  
Recurrent Bleeding ◽  
Pulmonary Artery Sling ◽  
Slide Tracheoplasty ◽  
Left Pulmonary Artery Sling

Abstract Background: Aortotracheal fistula (ATF) is an uncommon and fatal complication of tracheal or aortic surgery, especially among pediatric patients. Case presentation: We reported a case in a 1-year-old boy with dextrocardia, left pulmonary artery sling and long segment tracheal stenosis. He received slide tracheoplasty at 9 months of age and had post-operative refractory granulation at distal trachea status post repeated balloon dilatation and laser vaporization. Episodes of hemoptysis occurred on post-operative day 81. Bronchoscopy revealed a pulsating pseudoaneurysm at lower trachea which ruptured during the procedure. Urgent surgical repair under cardiopulmonary bypass with deep hypothermic circulatory arrest was done. No recurrent bleeding or significant neurologic deficits noticed at a 4-month follow-up. Conclusion: Congenital anomaly that changes the spatial relationship between trachea and aorta could have contributed to formation of ATF. This warrant future attention when managing tracheal granulation with this not uncommon anatomy.

A Case of Pulmonary Artery Sling Anomaly with Tracheal Stenosis and Management of Difficult Airway

2020 ◽  
Author(s):  
Emine G. Torun ◽  
Mutlu U. Yazıcı ◽  
Ebru Azapağası ◽  
Utku A. Örün ◽  
Hasibe G. Çınar ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Difficult Airway ◽  
Tracheal Stenosis ◽  
Pediatric Intensive Care ◽  
Male Infant ◽  
Left Pulmonary Artery ◽  
High Morbidity ◽  
Pulmonary Artery Sling ◽  
Vascular Abnormality ◽  
Pulmonary Sling

AbstractPulmonary artery sling is a rare congenital vascular abnormality, where the left pulmonary artery originates from the right pulmonary artery, passes between trachea, and esophagus and reaching the left hilum. Cough, wheezing, and difficulty in feeding are three major symptoms. Untreated pulmonary sling carries high morbidity and mortality, most of which is due to the airway and other associated anomalies. Herein, we report a 40-day-old male infant who admitted to the pediatric intensive care unit with progressive respiratory distress and diagnosed with left pulmonary sling with tracheal stenosis. We discuss the diagnosis and management of pulmonary artery sling and present the successful use of laryngeal mask in difficult airway management.

scholarly journals A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoqing Shi ◽  
Chuan Wang ◽  
Yimin Hua ◽  
Xiaoliang Liu ◽  
Hongyu Duan
Keyword(s):  
Pulmonary Artery ◽  
Tracheal Stenosis ◽  
Clinical Symptoms ◽  
Left Pulmonary Artery ◽  
Bronchial Tree ◽  
Middle Lobe ◽  
Pulmonary Artery Sling ◽  
Lobe Bronchus ◽  
Recurrent Wheezing ◽  
Poor Outcomes

Pulmonary artery sling (PAS) is a rare but fatal malformation. Patients with PAS tend to develop obstructive symptoms in few weeks of life. Conversely, some patients may be otherwise mild or asymptomatic in their early life. Currently, no consensus on the intervention timing and treatment strategy for asymptomatic and mild cases has been reached. Moreover, the extent of tracheal stenosis is another determining factor for the choice of intervention timing since clinical symptoms might not correspond well with the degree of stenosis. Lack of comprehensive assessment of entire airways confer underestimation of disease severity and in turn improper choice of treatment regimens and poor outcomes. Herein, we described an infantile case of PAS, who was scheduled initially for periodic outpatient follow-up on account of the absence of symptoms and inadequate imaging assessment at diagnosis. The patient developed recurrent wheezing and progressive respiratory distress at 7 months of age. After left pulmonary artery (LPA) reimplantation without tracheal intervention, bronchoscopy was performed due to failure to wean from mechanical ventilation, which demonstrated complete tracheal cartilage rings, a long segment tracheal stenosis, a low tracheal bifurcation at T6, and the absence of a separate right middle lobe bronchus. The patient was finally diagnosed with type IIb PAS and extubated successfully following conservative treatment. Miserably, neurological sequelae were devastating, leading to poor outcomes. Comprehensive airway evaluation using bronchoscopy is substantial to early identification of all components responsible for airway compromise in PAS anatomic subtypes. Considering severe concomitant maldevelopment of the bronchial tree in children with type IIb PAS, early and complete correction by surgery might decrease perioperative morbidities and mortalities of these patients.

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