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Seitova N, Tobylbayeva Z, Baimuratova M, Zhauarova G, Utebaliyev R, Bekpan A, Autalipov D, Ibrayev T. A promising solution to the urgent problem of cicatricial narrowing of the larynx and trachea in a pediatric patient with sling syndrome. Pediatr Pulmonol 2024; 59:2015-2016. [PMID: 38578139 DOI: 10.1002/ppul.27000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Nurgul Seitova
- Department of Anesthesiology and Intensive Care, Corporate Fund, University Medical Center, Astana, Kazakhstan
| | - Zaure Tobylbayeva
- Department of Anesthesiology and Intensive Care, Corporate Fund, University Medical Center, Astana, Kazakhstan
| | | | - Gulmira Zhauarova
- Department of Anesthesiology and Intensive Care, Corporate Fund, University Medical Center, Astana, Kazakhstan
| | - Ruslan Utebaliyev
- Pediatric Surgery Department, University Medical Center, Astana, Kazakhstan
| | - Almat Bekpan
- Pediatric Surgery Department, University Medical Center, Astana, Kazakhstan
| | - Darkhan Autalipov
- Pediatric Surgery Department, University Medical Center, Astana, Kazakhstan
| | - Talgat Ibrayev
- Department of Anesthesiology and Intensive Care, Corporate Fund, University Medical Center, Astana, Kazakhstan
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Kumbasar U, Uysal S, Doğan R. Congenital pulmonary malformations. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S60-S72. [PMID: 38584784 PMCID: PMC10995677 DOI: 10.5606/tgkdc.dergisi.2024.25713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 04/09/2024]
Abstract
There are many congenital anomalies of the lung, some of which have no clinical symptoms and are detected incidentally, while others, particularly in the neonatal and infant period, are recognized by their typical signs, symptoms, and radiological appearance. Some congenital lung anomalies are so important that they can cause the death of the patient if not diagnosed and treated early. Classification of congenital lung anomalies is difficult since these anomalies may be related to the airway, arterial and venous vascular system, pulmonary parenchyma, and primitive anterior intestinal anomalies from which the lung originates, and some anomalies may have several etiologic origins. In this review, all subgroups of congenital pulmonary malformations will be discussed.
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Affiliation(s)
- Ulaş Kumbasar
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Serkan Uysal
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Rıza Doğan
- Department of Thoracic Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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3
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Tsuji E, Morita K, Matsuhisa H, Bitoh Y, Hatakeyama T. Incidence of congenital tracheal stenosis in left pulmonary artery sling diagnosed by bronchoscopy. Pediatr Surg Int 2023; 39:240. [PMID: 37498341 DOI: 10.1007/s00383-023-05527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Congenital tracheal stenosis (CTS) has been reported to occur in 50-65% of cases of left pulmonary artery sling (LPAS), but the exact incidence rate is unknown. This study aimed to determine the actual rate using bronchoscopy and to elucidate morphological features in computed tomography (CT) diagnosis. METHODS We performed a single institutional retrospective review of all patients with LPAS between January 2010 and March 2022. The percentage of complete tracheal rings in patients with LPAS was evaluated using bronchoscopy. The anteroposterior/lateral diameter ratios at the smallest and largest diameters of each CTS patient's trachea were measured on CT. The Wilcoxon signed-rank test was used to analyze the differences between the two parts. RESULTS Fifty-two patients with LPAS were enrolled. All patients had complete tracheal rings on bronchoscopy. CT analysis of 32 patients with CTS was performed. The median anteroposterior/lateral diameter ratio at the smallest diameter was 1.05 (interquartile range [IQR] 0.95-1.15); the median ratio at the largest diameter was 0.94 (IQR 0.89-0.99). There was a significant difference between the two parts (p = 0.013). CONCLUSION CTS might be universally associated with LPAS. The circular tracheal cross-section on CT might imply the existence of a complete tracheal ring.
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Affiliation(s)
- Emi Tsuji
- Division of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keiichi Morita
- Division of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Hironori Matsuhisa
- Division of Pediatric Cardiovascular Surgery, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yuko Bitoh
- Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tadashi Hatakeyama
- Division of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Hu J, Wang H, Du X, Zhu L, Wang S, Zhang H, Xu Z, Chen H. Morphologic classification of tracheobronchial arborization in children with congenital tracheobronchial stenosis and the associated cardiovascular defects. Front Pediatr 2023; 11:1123237. [PMID: 37287629 PMCID: PMC10242125 DOI: 10.3389/fped.2023.1123237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Background We sought to classify patients with congenital tracheal stenosis (CTS) according to tracheobronchial morphology and determine anatomic features associated with tracheobronchial anomalies (TBAs) and concurrent cardiovascular defects (CVDs). Methods We enrolled 254 patients who underwent tracheoplasty between November 1, 2009 and December 30, 2018. The anatomic features of the tracheobronchial tree and cardiovascular system were abstracted from bronchoscopy, echocardiography, computerized tomography, and operative reports. Results Four types of tracheobronchial morphology were identified: Type-1, which included normal tracheobronchial arborization (Type-1A, n = 29) and tracheal bronchus (Type-1B, n = 22); Type-2 (tracheal trifurcation; n = 49), and Type-3 (typical bridging bronchus; n = 47). Type-4 (bronchus with an untypical bridging pattern) was divided into Type-4A (involving bronchial diverticulum; n = 52) and Type-4B (absent bronchus; n = 55). Carinal compression and tracheomalacia were significantly more frequent in Type-4 patients than in the other patients (P < 0.01). CVDs were common in patients with CTS, especially in patients with Type-3 and Type-4 (P < 0.01). Persistent left superior vena cava was most common among patients with Type-3 (P < 0.01), and pulmonary artery sling was most frequent among those with Type-4 (P < 0.01). Outflow tract defects were most likely to occur in Type-1B. Early mortality was detected in 12.2% of all patients, and young age (P = 0.02), operation in the early era (P < 0.01), and bronchial stenosis (P = 0.03) were proven to be risk factors. Conclusions We demonstrated a useful morphological classification for CTS. Bridging bronchus was most closely linked with vascular anomalies, while tracheal bronchus was frequently associated with outflow tract defects. These results may provide a clue to CTS pathogenesis.
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Affiliation(s)
- Jie Hu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinwei Du
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Limin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shunmin Wang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiwei Xu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Chen
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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5
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Harumatsu T, Shimojima N, Tomita H, Shimotakahara A, Komori K, Ieiri S, Hirobe S. Successful surgical treatment of congenital tracheal stenosis combined with tracheal bronchus and left pulmonary artery sling: a 10-year single-institution experience. Pediatr Surg Int 2022; 38:1363-1370. [PMID: 35779103 DOI: 10.1007/s00383-022-05161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Radical surgery for congenital tracheal stenosis (CTS) is technically demanding. CTS combined with tracheal bronchus (TB) and pulmonary artery (PA) sling is a particularly challenging condition. We herein report our successfully modified surgical techniques for CTS combined with TB and PA sling. METHODS Nine patients treated at our institution from July 2010 to December 2020 for CTS with TB and PA sling were enrolled. The patients' characteristics, operative results, and clinical outcomes were reviewed and analyzed retrospectively. RESULTS The mean age at the operation and body weight were 8.0 ± 4.4 months old and 6.5 ± 0.8 kg, respectively. The mean tracheal diameter and length of the stenotic lesion were 3.2 ± 1.0 mm (mean stenosis rate 46.2%) and 25.4 ± 4.9 mm, respectively. All cases were complicated with PA sling at bifurcation stenosis with tracheobronchomalacia. All patients underwent modified posterior-anterior slide tracheoplasty with an inverted Y-shaped incision at the bifurcation and repositioning of the PA. The mean postoperative intubation period was 25.0 ± 32.1 days. There were no major intraoperative or postoperative complications, including hypoxic-ischemic encephalopathy. The mean hospital stay was 92.2 ± 73.4 days. All patients were discharged home without tracheostomy or oxygen support. CONCLUSION Our slide tracheoplasty technique for CTS with TB and PA sling achieved excellent outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Toshio Harumatsu
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirofumi Tomita
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Koji Komori
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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6
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Liszewski MC, Ciet P, Winant AJ, Lee EY. Pediatric large airway imaging: evolution and revolution. Pediatr Radiol 2022; 52:1826-1838. [PMID: 35536417 DOI: 10.1007/s00247-022-05377-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
Abstract
Infants and children often present with respiratory symptoms referable to the airway. For these pediatric patients, airway imaging is frequently performed to evaluate for underlying disorders of the large airway. Various imaging modalities have been used to evaluate the pediatric large airway, and pediatric airway imaging techniques have continued to evolve. Therefore, clear understanding of the status and new advances in pediatric large airway imaging is essential for practicing radiologists to make timely and accurate diagnoses, which can lead to optimal pediatric patient management.
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Affiliation(s)
- Mark C Liszewski
- Departments of Radiology and Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th St., Bronx, NY, 10467, USA.
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Pediatric Respiratory Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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7
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Computed tomography and magnetic resonance imaging of vascular rings and other things: a pictorial review. Pediatr Radiol 2022; 52:1839-1848. [PMID: 35438331 DOI: 10.1007/s00247-022-05366-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Compression of the airway, esophagus or both by aortic and pulmonary vessels can be caused by a variety of anatomical situations. Vascular rings are the most commonly encountered entity; however, compression can also occur from less common anomalies such as a left pulmonary artery sling or innominate artery compression. Vascular rings and other vascular compression abnormalities can be challenging to visualize and image and often require advanced imaging by CT or MRI to better understand the cause and extent of compression. Atretic vascular structures, such as the ligamentum arteriosum or atretic arch, play a key role in creating a vascular ring and do not enhance with contrast agent in a typical fashion. Despite these imaging challenges, classic and useful signs can indicate the presence or absence of a vascular ring or compression.
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Kageyama S, Takeishi N, Harada N, Taniguchi K, Morita K, Wada S. Airway performance in infants with congenital tracheal stenosis associated with unilateral pulmonary agenesis: effect of tracheal shape on energy flux. Med Biol Eng Comput 2022; 60:2335-2348. [DOI: 10.1007/s11517-022-02601-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022]
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9
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Tedla B, Golding F, Ryan J, Sun HY. Fetal Diagnosis of Dextroposition, Left Pulmonary Artery Sling, Partial Anomalous Left Pulmonary Artery, and Aortic Coarctation. CASE (PHILADELPHIA, PA.) 2022; 6:114-118. [PMID: 35602990 PMCID: PMC9120859 DOI: 10.1016/j.case.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
•LPA sling is a rare anomaly definable by fetal echocardiography. •LPA sling is frequently associated with significant respiratory morbidity and mortality. •Fetal diagnosis should prompt planning for postnatal management at a pediatric center. •We present a fetal case of dextroposition, partial LPA sling, and aortic coarctation. •Progressive dextroposition was an indicator for the presence of an LPA sling.
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Affiliation(s)
- Bruke Tedla
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children’s Hospital, UC San Diego School of Medicine, San Diego, California
| | - Fraser Golding
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children’s Hospital, UC San Diego School of Medicine, San Diego, California
| | - Justin Ryan
- Division of Cardiovascular Surgery, Department of Surgery, Rady Children’s Hospital, UC San Diego School of Medicine, San Diego, California
| | - Heather Y. Sun
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children’s Hospital, UC San Diego School of Medicine, San Diego, California
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10
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Yin W, Liontos A, Koepke J, Ghoul M, Mazzocchi L, Liu X, Lu C, Wu H, Fysikopoulos A, Sountoulidis A, Seeger W, Ruppert C, Günther A, Stainier DYR, Samakovlis C. An essential function for autocrine hedgehog signaling in epithelial proliferation and differentiation in the trachea. Development 2022; 149:274222. [PMID: 35112129 PMCID: PMC8918789 DOI: 10.1242/dev.199804] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
The tracheal epithelium is a primary target for pulmonary diseases as it provides a conduit for air flow between the environment and the lung lobes. The cellular and molecular mechanisms underlying airway epithelial cell proliferation and differentiation remain poorly understood. Hedgehog (HH) signaling orchestrates communication between epithelial and mesenchymal cells in the lung, where it modulates stromal cell proliferation, differentiation and signaling back to the epithelium. Here, we reveal a previously unreported autocrine function of HH signaling in airway epithelial cells. Epithelial cell depletion of the ligand sonic hedgehog (SHH) or its effector smoothened (SMO) causes defects in both epithelial cell proliferation and differentiation. In cultured primary human airway epithelial cells, HH signaling inhibition also hampers cell proliferation and differentiation. Epithelial HH function is mediated, at least in part, through transcriptional activation, as HH signaling inhibition leads to downregulation of cell type-specific transcription factor genes in both the mouse trachea and human airway epithelial cells. These results provide new insights into the role of HH signaling in epithelial cell proliferation and differentiation during airway development. Summary: A conserved autocrine role for HH signaling in tracheal epithelial cell proliferation and differentiation is revealed, suggesting potential new interventions for airway epithelial proliferation and differentiation defects.
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Affiliation(s)
- Wenguang Yin
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, People's Republic of China.,Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Bad Nauheim 61231, Germany
| | - Andreas Liontos
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, S-10691 Stockholm, Sweden.,Science for Life Laboratory, Stockholm University, Solna 171 21, Sweden
| | - Janine Koepke
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany
| | - Maroua Ghoul
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany
| | - Luciana Mazzocchi
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany
| | - Xinyuan Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, People's Republic of China
| | - Chunyan Lu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, People's Republic of China
| | - Haoyu Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510182, People's Republic of China
| | - Athanasios Fysikopoulos
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany
| | - Alexandros Sountoulidis
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, S-10691 Stockholm, Sweden.,Science for Life Laboratory, Stockholm University, Solna 171 21, Sweden
| | - Werner Seeger
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany.,Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Clemens Ruppert
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany
| | - Andreas Günther
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany
| | - Didier Y R Stainier
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Bad Nauheim 61231, Germany
| | - Christos Samakovlis
- Cardio-Pulmonary Institute, Member of the German Center for Lung Research (DZL), University of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen 35392, Germany.,Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, S-10691 Stockholm, Sweden.,Science for Life Laboratory, Stockholm University, Solna 171 21, Sweden.,Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
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Abstract
Vascular rings are congenital aortic arch anomalies that lead to compression of the trachea or esophagus. The goal of this review is to summarize our current recommendations for the management of patients with a diagnosis of a vascular ring. We review the history, classification methods, and epidemiology of the various types of vascular rings. We then propose a management strategy for the relatively new paradigm of fetal diagnosis, including the management of asymptomatic vascular rings. Finally, we finish with a review of the operative techniques and outcomes for the four main categories of vascular rings.
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12
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Mercan İ, Akyuz M, Işık O. Pulmonary artery sling in a symptomatic newborn. J Cardiovasc Thorac Res 2021; 13:254-257. [PMID: 34630975 PMCID: PMC8493231 DOI: 10.34172/jcvtr.2021.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/25/2020] [Indexed: 11/09/2022] Open
Abstract
Pulmonary arterial sling (PAS) is a relatively rare congenital anomaly in which left pulmonary artery branch originates abnormally from the right pulmonary artery, eventually resulting with respiratory symptoms, due to airway obstruction. In this report, we present a PAS in a neonate who showed progressive respiratory distress in the second week following delivery. At 25 days of age, the patient underwent total surgical correction of the anomaly, during which left pulmonary artery reimplantation to main pulmonary artery without the use of cardiopulmonary bypass was employed. Following an uneventful recovery, the patient was discharged eighteen days after surgery.
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Affiliation(s)
- İlker Mercan
- Department of Pediatric Heart Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Muhammet Akyuz
- Department of Pediatric Heart Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Onur Işık
- Department of Pediatric Heart Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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13
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Yu D, Guo Z, You X, Peng W, Qi J, Sun J, Wu K, Li X, Mo X. Long-term outcomes in children undergoing vascular ring division: a multi-institution experience. Eur J Cardiothorac Surg 2021; 61:605-613. [PMID: 34632492 PMCID: PMC8858591 DOI: 10.1093/ejcts/ezab432] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of patients with vascular ring division. METHODS A multi-institution retrospective review of 371 patients with vascular rings undergoing surgical division at 3 paediatric cardiac institutions between November 2007 and October 2019 was performed. RESULTS The complete vascular rings consisted of a double aortic arch (24.5%), right aortic arch with left ligamentum arteriosum (36.7%) and left aortic arch, with right ligamentum arteriosum (0.5%). The incomplete vascular rings consisted of a pulmonary artery sling (22.9%), left aortic arch with aberrant right subclavian artery (15.1%) and innominate artery compression syndrome (0.3%). Respiratory symptoms included stridor (71.4%), wheezing (49.1%), coughing (31.5%), gastrointestinal symptoms included choking (12.4%), dysphagia (3.2%) and emesis (1.9%). Only one patient died after discharge, yielding a late mortality rate of 0.3% (1/360). The 10-year overall survival rate was 96.8%. Postoperative complications were reported in 51 patients, 15 of whom required reoperation. The 10-year freedom from reoperation rate was 95.9%. Follow-up was completed in 95.4% (354/371) of patients, with a mean follow-up time of 4.3 ± 2.9 years (range from 1 to 13 years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up. CONCLUSIONS The outcomes of vascular ring division are excellent. A Kommerell diverticulum >1.5 times the aberrant left subclavian artery origin is an operative indication for primary resection. Tracheomalacia is a risk factor for reoperation and residual symptoms, and preoperative fibrobronchoscopy is important for evaluation.
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Affiliation(s)
- Di Yu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhangke Guo
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin You
- Department of Cardiac Surgery, Children's Hospital of Suqian, Suqian, China
| | - Wei Peng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Sun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Kaihong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaofeng Li
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Li S, Wu L, Huang M, Zhou J, Wang Y, Chen Z. Cardiopulmonary bypass as a bridge for bronchial foreign body removal in a child with pulmonary artery sling: A case report. Medicine (Baltimore) 2021; 100:e26908. [PMID: 34397925 PMCID: PMC8360435 DOI: 10.1097/md.0000000000026908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Successful removal of an airway foreign body (FB) in some intractable cases can be very challenging, because of tracheal anomalies, unstable respiratory status of the patients, and the location of FB. The use of cardiopulmonary bypass (CPB) support for the treatment of a FB is extremely rare. PATIENT CONCERNS We present a case of a 39-month-old previously healthy girl who was admitted to our hospital for suspected FB aspiration (FBA). Initially, the attempt for removal of the FB by conventional bronchoscopy failed because of hypoxic intolerance. DIAGNOSES Bronchoscopy revealed tracheal anomalies and subsequent computed tomography angiography demonstrated the presence of a pulmonary artery sling (PAS), which confirmed the diagnosis of PAS accompanied with FBA. INTERVENTIONS With the assistance of CPB, multidisciplinary treatment involving the respiratory, cardiothoracic and anesthetic teams were involved and the bronchial FB was removed by flexible bronchoscopy successfully and then PAS was corrected by surgical intervention. OUTCOMES The patient remained asymptomatic, without shortness of breath or wheezing during the 15 months follow-up. LESSONS This case highlights that in a complicated case of FBA, bronchoscopy and computed tomography imaging are of great importance to achieve an accurate diagnosis, and a multidisciplinary treatment approach is essential for a satisfactory outcome. If the patient is unstable for bronchoscopy, CPB can be temporarily used in the stabilization of the patient to allow safe removal of the FB.
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Affiliation(s)
- Shuxian Li
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lei Wu
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Meixia Huang
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Junfen Zhou
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China
| | - Yingshuo Wang
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zhimin Chen
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Ramaswamy M, Rudrappa S, Beeman A, Heatwole A, McIntosh N, McIntyre D, Hewitt R, Muthialu N. Lung Hypoplasia Associated With Ring-Sling Complex Is Usually Right-Sided. Ann Thorac Surg 2021; 113:884-888. [PMID: 33607054 DOI: 10.1016/j.athoracsur.2021.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary artery sling (PAS) is usually associated with long-segment congenital tracheal stenosis (LSCTS). This combination of abnormalities can also be associated with lung hypoplasia abnormalities (hypoplasia, aplasia, or agenesis). This study analyzed the association of lung hypoplasia abnormalities with combined PAS and LSCTS and its influence on its surgical outcomes. METHODS All patients (0 to 18 years) who underwent surgical procedures for both PAS and LSCTS from 1995 to 2019 were analyzed retrospectively for mortality, ventilation days, and intensive care unit days by dividing them into those with normal lungs (group 1) and hypoplastic lungs (group 2). RESULTS Included were 75 patients (30 girls [40%]), who were a median age of 5.7 months (interquartile range [IQR], 2.9-13.3 months), median weight of 5.5 kg (IQR, 4.1-7.9 kg), and had a median follow-up of 99.8 months (IQR, 54.5-152.0 months); of these, 8 patients (10.7%) had hypoplastic right lung, comprising hypoplasia in 7 (87.5%), aplasia in 1 (12.5%), and agenesis in 0 (0%). There was a significant difference in mortality (group 1, 9.0%; group 2, 50%; P = .007) but no significant difference in median ventilation days (group 1, 9.0; group 2, 9.0; P = .89) or in median intensive care unit days (group 1, 14.0; group 2, 11.5; P = .44). CONCLUSIONS Lung hypoplasia associated with PAS and LSCTS is usually right-sided. As a result of severe airway obstruction and single-lung physiology, there is a high requirement of preoperative cardiorespiratory support and a significant association with adverse surgical outcomes.
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Affiliation(s)
- Madhavan Ramaswamy
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Siddartha Rudrappa
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Arun Beeman
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Amy Heatwole
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Neil McIntosh
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Denise McIntyre
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Richard Hewitt
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
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16
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Stephens EH, Eltayeb O, Kennedy C, Rigsby CK, Rastatter JC, Carr MR, Mongé MC, Backer CL. Influence of Fetal Diagnosis on Management of Vascular Rings. Ann Thorac Surg 2021; 113:630-636. [PMID: 33524348 DOI: 10.1016/j.athoracsur.2021.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/12/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There has been an increasing frequency of fetal diagnosis of vascular rings. We compared management strategies and outcomes of infants with fetal diagnosis to those with postnatal diagnosis to inform recommendations regarding optimal management. METHODS Retrospective review was performed of vascular ring operations from 1/2000 to 6/2019. Standard demographic data (preoperative clinical status, timing of diagnosis, cross-sectional imaging, operative and perioperative details, and clinical outcomes) were collected. Statistical analysis was performed to compare characteristics and outcomes of fetal versus postnatal diagnosis. RESULTS There were 190 patients, with 15% (n=29) diagnosed prenatally. Anatomic variants were: double aortic arch (n=66, 14 fetal diagnosis), right aortic arch, aberrant left subclavian artery (n=94, 12 fetal diagnosis), circumflex aorta (n=7, 1 fetal diagnosis), and pulmonary artery sling (n=19, 2 fetal diagnoses). Increasing frequency of fetal diagnosis was noted in the past 10 years. In 2012 1/9 (11%) patients had a fetal diagnosis, in 2018 8/11 (72%) had a fetal diagnosis (p<0.001). Patients with a fetal diagnosis were significantly younger at the time of surgery (13.1 months [20.6] vs. 24.0 months [87.0], p=0.029). There was no difference in postoperative complications or length-of-stay (3 days [1] for fetal diagnosis vs. 4 days [3] for postnatal diagnosis, p=0.50). CONCLUSIONS Fetal diagnosis leads to the potential for expectant management of vascular ring patients. This has resulted in earlier time of intervention with no increase in postoperative morbidity. This may lead to improved long-term outcomes and potentially alter the natural history for these children.
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Affiliation(s)
| | - Osama Eltayeb
- Divisions of Cardiovascular-Thoracic Surgery, Medical Imaging; Divisions of Cardiovascular-Thoracic Surgery, Departments of Radiology
| | - Clare Kennedy
- Divisions of Cardiovascular-Thoracic Surgery, Medical Imaging
| | - Cynthia K Rigsby
- Divisions of Cardiovascular-Thoracic Surgery, Otorhinolaryngology- Head & Neck Surger; Divisions of Cardiovascular-Thoracic Surgery, Departments of Pediatrics; Divisions of Cardiovascular-Thoracic Surgery, Departments of Otolaryngology
| | - Jeffrey C Rastatter
- Divisions of Cardiovascular-Thoracic Surgery, and Cardiology; Northwestern University Feinberg School of Medicine, Chicago, Illinois, and Section of Pediatric Cardiothoracic Surgery
| | - Michael R Carr
- Divisions of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Departments of Surgery; Divisions of Cardiovascular-Thoracic Surgery, Departments of Otolaryngology
| | - Michael C Mongé
- Divisions of Cardiovascular-Thoracic Surgery, Medical Imaging; Divisions of Cardiovascular-Thoracic Surgery, Departments of Radiology
| | - Carl L Backer
- UK HealthCare Kentucky Children's Hospital, Lexington, Kentucky; and Department of Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Abstract
OBJECTIVE Review a single-centre experience with pulmonary artery sling repair and evaluate risk factors for re-intervention. METHODS Patients with surgically repaired pulmonary artery sling at a single institution between 1996 and 2018 were retrospectively reviewed. A univariate Cox regression analysis was used to evaluate variables for association with freedom from re-intervention. RESULTS Eighteen patients had pulmonary artery sling repair. At operation, median age and weight were 6.9 months (interquartile range 4.1-18.1) and 9.5 kg (interquartile range 6.5-14.5), respectively. A median hospital length of stay was 12 days (interquartile range 5.8-55.3). Twelve patients (67%) had complete tracheal rings, of whom six (50%) underwent tracheoplasty (five concurrently with pulmonary artery sling repair). Airway re-intervention was required in five (83%) of the six patients who underwent tracheoplasty. One patient had intraoperative diagnosis and repair of pulmonary artery sling during unrelated lesion repair and required tracheoplasty 24 days post-operatively. One patient died 55 days after pulmonary artery sling repair and tracheoplasty following multiple arrests and re-interventions. Median post-operative follow-up for surviving patients was 6.3 years (interquartile range 11 months-13 years), at which time freedom from re-intervention was 61%. When controlling for patient and tracheal size, initial tracheoplasty was associated with decreased freedom from re-intervention (hazard ratio 21.9, 95% confidence interval 1.7-284.3, p = 0.018). CONCLUSIONS In patients with pulmonary artery sling, tracheoplasty is associated with decreased freedom from re-intervention. In select patients with pulmonary artery sling and complete tracheal rings, conservative management without tracheoplasty is feasible. Further study is necessary to delineate objective indications for tracheoplasty.
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18
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Tracheal development after left pulmonary artery reimplantation: an individual study. Sci Rep 2020; 10:17702. [PMID: 33077818 PMCID: PMC7572416 DOI: 10.1038/s41598-020-74890-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022] Open
Abstract
Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.
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19
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Tracheoplasty for Patients with Pulmonary Artery Sling and Tracheal Stenosis: A Meta-Analysis. Pediatr Cardiol 2020; 41:1376-1385. [PMID: 32494877 DOI: 10.1007/s00246-020-02386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023]
Abstract
We performed this meta-analysis to assess the safety and efficacy of tracheoplasty for patients with pulmonary artery sling (PAS) and tracheal stenosis. Published studies that included surgical treatment of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and Cochrane Library databases until May 2020. The outcomes assessed included postoperative ventilation time, early and late mortality, and follow-up respiratory symptoms. The mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CI) was estimated with a random-effects/fixed-effects model. Subgroup analysis was performed stratified by percentage of patients with tracheal rings. A total of eight studies comprising 219 patients with PAS accompanied by tracheal stenosis were included. The pooled estimates of postoperative ventilation time (MD 17.68, 95% CI 6.38 to 28.98, p < 0.01) and early mortality (RR 3.93, 95% CI 1.55 to 9.95, p < 0.01) favored the repair-only group. Late mortality (RR 1.33, 95% CI 0.48 to 3.68, p = 0.58) and respiratory symptoms (RR 1.51, 95% CI 0.50 to 4.57, p = 0.47) at follow-up showed no significant differences between the groups with repair-only and repair with tracheoplasty. The same results were found in subgroup analyses. For the surgical treatment of PAS with tracheal stenosis, repair without tracheoplasty appears to result in shorter postoperative ventilation time and lower early mortality, with no increase in late mortality or respiratory symptoms at follow-up, compared with concomitant tracheoplasty.
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20
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Sengupta A, Murthy RA. Congenital tracheal stenosis & associated cardiac anomalies: operative management & techniques. J Thorac Dis 2020; 12:1184-1193. [PMID: 32274199 PMCID: PMC7139091 DOI: 10.21037/jtd.2019.10.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital tracheal stenosis can lead to symptomatic airway obstruction in children and often mandates surgical correction. Over the past half-century, numerous tracheal reconstruction techniques have been developed, including tracheal resection with end-to-end anastomosis (for short-segment complete tracheal stenosis), patch tracheoplasty, slide tracheoplasty, and homograft and autograft augmentation repairs. However, operative management of congenital tracheal stenosis is often complicated by the presence of congenital heart disease, the most common of which is pulmonary artery sling. When present concomitantly, combined repair of both defects is feasible and is currently the preferred approach. Questions have been raised about the optimal timing and sequence of surgery, and some have advocated staged repair for patients with complex associated cardiac lesions. However, evidence from the past two decades suggests that concomitant repair can be performed with excellent results. The current standard of care involves the use of cardiopulmonary bypass to simultaneously repair the tracheal defect using slide tracheoplasty and all associated cardiac anomalies. Advances in operative techniques and extracorporeal circulation, progressive understanding of the pathological basis of combined congenital tracheal and cardiac disease, and a multidisciplinary approach to patient care have all contributed to the successful outcomes seen in the modern era. This article describes the combined surgical correction of tracheal stenosis and double-outlet right ventricle-tetralogy of Fallot type in an infant, provides a detailed step-by-step description for performing a slide tracheoplasty along with various other less favored tracheoplasty techniques, and reviews the current literature discussing such combined repairs.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav A Murthy
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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Fukushima N, Shimojima N, Ishitate M, Miyakawa T, Hirobe S, Miura M. Clinical and structural aspects of tracheal stenosis and a novel embryological hypothesis of left pulmonary artery sling. Pediatr Pulmonol 2020; 55:747-753. [PMID: 31975532 DOI: 10.1002/ppul.24661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify the imaging features peculiar to congenital tracheal stenosis (CTS) complicated with left pulmonary artery sling (LPAS) with the aim of presenting a hypothesis of tracheal stenosis embryology in LPAS. METHODS We retrospectively reviewed CTS patients (with complete cartilaginous rings) admitted between April 2010 and July 2018. All the patients were classified into the LPAS or non-LPAS group, and their clinical characteristics and qualitative variables on computed tomography (CT) imaging were compared. RESULTS Of the 72 patients enrolled, 61 had bilateral lungs. Among the bilateral lung patients, 26 (43%) had LPAS. The tracheal bifurcation was significantly deeper, the stenotic region was longer, and the bronchial angle (especially in the right) was wider, in the LPAS group. The cut-off values for the thoracic vertebral level at the tracheal bifurcation (>4.8), subcarinal angle (>118.1), and right bronchial angle (>61.9) were useful for diagnosing suspected cases of LPAS. In the time-dependent course, LPAS complicated with a congenital heart defect was a statistically significant risk factor of respiratory symptoms (hazard ratio, 3.01; 95% confidence interval, 1.23-7.37; P = .02). CONCLUSIONS The CT findings described here should immediately raise suspicion of LPAS on chest X-ray and also suggest tracheal "squeezing and milking" by the surrounding vessels in the embryo. Patients with LPAS complicated with a heart defect should be followed carefully to determine the optimal timing of intervention.
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Affiliation(s)
- Naoya Fukushima
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan.,Department of Pediatrics, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Makoto Ishitate
- Department of Respiratory Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Tomoo Miyakawa
- Department of Respiratory Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
| | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan
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Song X, Lu Z, Zhu L, Du X, Wang S, Xu Z. Morphologic Analysis of Congenital Heart Disease With Anomalous Tracheobronchial Arborization. Ann Thorac Surg 2020; 110:1387-1395. [PMID: 32114043 DOI: 10.1016/j.athoracsur.2020.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/28/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study investigated the morphologic characteristics of congenital heart disease (CHD) combined with anomalous tracheobronchial arborization (ATBA) to provide new considerations for surgically treating congenital tracheal stenosis. METHODS A retrospective review of surgical experience with ATBA was conducted of 147 patients. The proportion of patients with ATBA combined with tracheal stenosis was determined. Four ATBA types were identified: type A, tracheal bronchus (n = 58); type B, bronchial trifurcation (n = 46); type C, bridging bronchus (n = 38); and type D, tracheal bronchus combined with bronchial trifurcation (n = 5). The rate of tracheoplasty for each type was determined. We measured the carina/pseudocarina angle and assessed the distribution of CHD, especially pulmonary artery sling. RESULTS The tracheal diameter of 14 patients (24.1%) with type A and 5 patients (10.9%) with type B was normal. There were 128 patients with tracheal stenosis and complete tracheal rings; of them, 113 patients received tracheoplasty. The tracheoplasty rate was higher for type C than type A (100% vs 62.1%, P < .001). The carina/pseudocarina angle was significantly reduced postoperatively (P < .001). The repair in 78 patients (60.9%) was combined with a pulmonary artery sling. A pulmonary azygos lobe was found in 10 patients (6.8%) and was resected. CONCLUSIONS ATBA is common in patients with congenital tracheal stenosis and may be associated with abnormal embryonic development. The new classification of ATBA has clinical significance in treating patients with congenital tracheal stenosis. The poor tracheal development cannot be explained merely with vascular compression. Tracheoplasty is currently the optimal option for every type.
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Affiliation(s)
- Xiaoqi Song
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhaohui Lu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Limin Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinwei Du
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shunmin Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Zhiwei Xu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Harada A, Shimojima N, Shimotakahara A, Azuma S, Ishizuka Y, Tomita H, Hirobe S. Surgical indication for congenital tracheal stenosis complicated by pulmonary artery sling. J Thorac Dis 2019; 11:5474-5479. [PMID: 32030266 DOI: 10.21037/jtd.2019.11.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Congenital tracheal stenosis (CTS) is a rare and life-threatening disease in children. Although pulmonary artery sling (PA sling) complicated by CTS sometimes occurs, there are few reports detailing the management of CTS with PA sling. The purpose of this retrospective study was to determine the appropriate indications for surgical intervention for CTS complicated by PA sling. Methods We evaluated 42 patients (19 males and 23 females) with the median age of 9.9±3.3 months (range, 5-34 months) with CTS complicated by PA sling who were treated at our hospital between 2005 and 2018. Twenty-eight patients received both a slide tracheoplasty and PA re-implantation, and 14 patients were managed conservatively for CTS. Among the latter, nine patients received PA re-implantation only, and five were managed conservatively without any surgery. We determined the surgical indications by retrospectively comparing the DLR value [tracheal diameter (mm)/stenotic length ratio], history of ventilator respiration, mortality rate, and post-operative course of patients at a single institution. Results The cut-off value for the DLR was determined to be 5.9 (sensitivity: 0.929, specificity: 0.714) by using the ROC curve (AUC 0.89, P<0.05). Conclusions A DLR value under 5.9 may serve as a new surgical indication for CTS complicated by PA sling.
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Affiliation(s)
- Atsushi Harada
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Saya Azuma
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yoshiaki Ishizuka
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirofumi Tomita
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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24
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Li D, Zhou X, Li M, Liu X. Surgical treatment of pulmonary artery sling and tracheal stenosis with or without tracheoplasty: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17449. [PMID: 31577770 PMCID: PMC6783154 DOI: 10.1097/md.0000000000017449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary artery sling (PAS) is rare, often with tracheal stenosis. And the postoperative mortality is high. For now, there is no consensus on the tracheoplasty for the patients with PAS and tracheal stenosis. METHODS Studies involving surgical repair of PAS and tracheal stenosis with and without tracheoplasty were identified by searching the PubMed, EMBASE, and the Cochrane Library databases until June 5, 2019. The assessed variables included ventilation time, early and late mortality, and symptom at follow-up. A random-effect/fixed-effect model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence interval (CI). RESULTS This study will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will assess the safety and efficacy of tracheoplasty for patients with PAS and tracheal stenosis, and provide more evidence-based guidance in clinical practice. PROSPERO REGISTRATION NUMBER CRD42019139788.
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery
| | - Xu Zhou
- Evidence-based Medicine Research Center, School of Basic Medical Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang
| | | | - Xiaojing Liu
- Laboratory of Cardiovascular Disease, West China Hospital, Sichuan University, Chengdu, PR China
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Liszewski MC, Ciet P, Lee EY. MR Imaging of Lungs and Airways in Children:. Magn Reson Imaging Clin N Am 2019; 27:201-225. [DOI: 10.1016/j.mric.2019.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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26
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Yong MS, Zhu MZL, Bell D, Alphonso N, Brink J, d'Udekem Y, Konstantinov IE. Long-term outcomes of surgery for pulmonary artery sling in children. Eur J Cardiothorac Surg 2019; 56:5305059. [PMID: 30715328 DOI: 10.1093/ejcts/ezz012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/06/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pulmonary artery (PA) sling is a rare vascular anomaly often associated with congenital tracheal stenosis. We describe the long-term outcomes with repair of this condition. METHODS A retrospective study was conducted at 2 institutions. From 1984 to 2018, 33 patients with PA sling underwent repair. RESULTS The median age at the time of surgery was 5.9 months (quartile 1-3: 2.5-12 months). Concomitant tracheal surgery was required in 21 patients (64%) where slide tracheoplasty was used in 11 patients (52%). There were no early deaths in patients who did not require tracheal surgery (n = 12). Operative mortality was 22% (2 of 9 patients) between 1984 and 1993, 11% (1 of 9 patients) between 1994 and 2003 and 6.7% (1 of 15 patients) between 2004 and 2018. The 15-year probability of survival for patients who had PA sling repair alone was 100%, and for patients who required PA sling and tracheal repair was 76 ± 10% (95% confidence interval 51-89%) (P = 0.08). The mean follow-up for survivors was 14 ± 9.8 years (3 months-33 years). All survivors were in the New York Heart Association functional class I/II at the last follow-up. Spirometry performed at a median age of 10.4 years after PA sling and tracheal surgery demonstrated obstructive lung defects with median forced expiratory volume in 1 s of 1.0 l (48% predicted), forced vital capacity of 1.5 l (74% predicted) and forced expiratory volume in 1 s/forced vital capacity of 0.69 (78% predicted). CONCLUSIONS Early mortality after PA sling repair is determined by the need for tracheal surgery. Though late survival was excellent, and the majority of survivors remained asymptomatic, long-term respiratory assessment and follow-up is warranted for these patients.
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Affiliation(s)
- Matthew S Yong
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Douglas Bell
- Department of Cardiac Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Nelson Alphonso
- Department of Cardiac Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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Three-dimensional printed degradable splint in the treatment of pulmonary artery sling associated with severe bilateral bronchus stenosis. Cardiol Young 2018; 28:1477-1480. [PMID: 30303052 DOI: 10.1017/s1047951118001579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pulmonary artery sling is a congenital cardiovascular disease and is usually accompanied by tracheobronchial stenosis. Generally, infants diagnosed with pulmonary artery sling should have surgery. However, the treatment of tracheobronchial stenosis is still controversial. Our team developed a customised, degradable, three-dimensional printed splint and successfully applied it in the treatment of pulmonary artery sling associated with severe bilateral bronchus stenosis. We suggested that three-dimensional printing may be a novel and effective way to treat tracheobronchial stenosis and other diseases in children.
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Cetrano E, Trezzi M, Secinaro A, Di Chiara L, Trozzi M, Bottero S, Polito A, Carotti A. Bronchial Mismatch as a Predictor of Respiratory Failure After Congenital Tracheal Stenosis Repair. Ann Thorac Surg 2018; 105:1264-1271. [PMID: 29397926 DOI: 10.1016/j.athoracsur.2017.10.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/07/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to identify predictors of postoperative respiratory failure after surgical tracheoplasty for congenital tracheal stenosis. METHODS Between February 2011 and April 2017, 16 infants underwent congenital tracheal stenosis repair. Preoperative computed tomography evaluation of the trachea and mainstem bronchi was performed. The primary outcome was midterm freedom from postoperative respiratory failure defined as persistent need for mechanical ventilation or surgical tracheobronchial reoperation. Bronchial mismatch, defined as [1 - (smaller bronchus diameter / larger bronchus diameter)] × 100, was analyzed in relation to the primary outcome. RESULTS Median age was 106 days (range, 1 to 406) and median weight was 5.3 kg (range, 2.6 to 8 kg). Four patients were neonates (25%) and 6 had genetic abnormalities (37.5%). There were no early nor late deaths. Median ventilation time was 5.5 days (range, 3 to 45). Mean follow-up time was 2.2 years (range, 0.1 to 4.5). Four patients with bronchial mismatch greater than 20% had postoperative respiratory failure (p = 0.002). Two of them underwent tracheostomy and were discharged with ventilation home care support. One underwent successful reoperation consisting of bilateral bronchial plasty with autologous cartilage rib grafts, and the other underwent successful right bronchial and tracheal reconstruction. One patient with bilateral bronchial hypoplasia underwent slide tracheoplasty associated with preemptive bilateral bronchial plasty and made a full recovery. CONCLUSIONS Surgical treatment of congenital tracheal stenosis in neonates and infants portends a good outcome. Bronchial mismatch greater than 20% can identify a subset of patients at increased risk for surgical reintervention and chronic respiratory failure. Slide tracheoplasty with preemptive bronchial reconstruction may prevent postoperative respiratory failure.
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Affiliation(s)
- Enrico Cetrano
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Matteo Trezzi
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Department of Radiology-Bioimaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luca Di Chiara
- Department of Cardiac Anesthesiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marilena Trozzi
- Department of Airway Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Sergio Bottero
- Department of Airway Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Angelo Polito
- Pediatric Intensive Care Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Adriano Carotti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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29
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Torre M. Left pulmonary artery sling and congenital tracheal stenosis: to slide or not to slide? J Thorac Dis 2018; 9:4881-4883. [PMID: 29312682 DOI: 10.21037/jtd.2017.11.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michele Torre
- Units of Pediatric Surgery and Airway Team, Istituto Giannina Gaslini, Genova, Italy
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30
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Arcieri L, Giordano R, Murzi B. To do or not to do? The management dilemma of congenital tracheal stenosis in the setting of the ring-sling complex. J Thorac Dis 2017; 9:4896-4898. [PMID: 29312686 DOI: 10.21037/jtd.2017.11.79] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Luigi Arcieri
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Bruno Murzi
- Pediatric Cardiac Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
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31
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Dumpa V, Gupta P, Iqbal V, Nair J. Term Neonate with Respiratory Distress. Neoreviews 2017; 18:e611-e614. [PMID: 30686935 PMCID: PMC6347399 DOI: 10.1542/neo.18-10-e611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Puneet Gupta
- Department of Pediatric Radiology, Women and Children's Hospital of Buffalo, Buffalo, NY
| | - Vaseem Iqbal
- Department of Pediatric Radiology, Women and Children's Hospital of Buffalo, Buffalo, NY
| | - Jayasree Nair
- Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY
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32
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Ando M, Nagase Y, Hasegawa H, Takahashi Y. External stenting: A reliable technique to relieve airway obstruction in small children. J Thorac Cardiovasc Surg 2017; 153:1167-1177. [PMID: 28242014 DOI: 10.1016/j.jtcvs.2016.12.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Airway obstruction in children may be caused by conditions such as vascular compression and congenital tracheobronchomalacia. Obstructive pulmonary vascular disease may be a detrimental sequel for patients with congenital heart disease. We evaluate our own original external stenting technique as a treatment option for these patients. METHODS Ninety-eight patients underwent external stenting (1997-2015). Cardiovascular anomalies were noted in 82 (83.7%). Nine patients had hypoplastic left heart syndrome and 6 had other types of single-ventricular hearts. RESULTS The median age at the first operation was 7.2 months (range, 1.0-77.1 months). The mechanisms were tracheobronchomalacia with (n = 46) or without (n = 52) vascular compression. Patients underwent 127 external stentings for 139 obstruction sites (62 trachea, 55 left bronchus, and 22 right bronchus). The stent sizes varied from 12 to 16 mm. There were 14 (8 in the hospital and 6 after discharge) mortality cases. Nine required reoperation for restenosis and 3 required stent removal for infection. The actuarial freedom from mortality and any kind of reoperation was 74.7% ± 4.6% after 2.8 years. The negative pressure threshold to induce airway collapse for congenital malacia (n = 58) improved from -15.9 to -116.0 cmH2O. A follow-up computed tomography scan (>2.0 years interval from the operation; n = 23) showed the mean diameter of the stented segment at 88.5% ± 13.7% (bronchus) and 94.5% ± 8.2% (trachea) of the reference. CONCLUSIONS External stenting is a reliable method to relieve airway compression for small children, allowing an age-proportional growth of the airway.
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Affiliation(s)
| | | | - Hisaya Hasegawa
- Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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33
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Weber A, Donner B, Perez MH, Di Bernardo S, Trachsel D, Sandu K, Sekarski N. Complicated Postoperative Course after Pulmonary Artery Sling Repair and Slide Tracheoplasty. Front Pediatr 2017; 5:67. [PMID: 28443268 PMCID: PMC5385459 DOI: 10.3389/fped.2017.00067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Pulmonary artery sling (PAS) is a rare congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery, and then passes between the trachea and the esophagus to reach the left lung, thereby forming a sling around the airway. It is often associated with intrinsic tracheal stenosis due to complete cartilaginous rings. Therapeutic management nowadays consists of one-stage reimplantation of the LPA and tracheoplasty with cardiopulmonary bypass support. Here, we present a 7-week-old boy with PAS and long-segment tracheal stenosis (LSTS) who underwent surgical intervention consisting of reimplantation of the LPA and slide tracheoplasty. Multiple respiratory and cardiovascular complications marked the postoperative course. They consisted of recurrent failed attempts in weaning off mechanical ventilation due to bronchomalacia, left vocal cord paralysis, development of granulation tissue at the anastomosis and restenosis of the trachea, and the main stem bronchi requiring balloon dilatation. The patient also developed bilateral pulmonary artery thrombosis and stenosis of the LPA. After a prolonged hospitalization, the patient is doing well without any respiratory symptoms and has a good result on follow-up bronchoscopy 1 year after the initial surgery. The stenosis of the LPA responded well to percutaneous balloon dilatation 12 months after the primary surgery. The case illustrates that even though surgical techniques are improving and are in general associated with a low morbidity and mortality, management of PAS and tracheal stenosis can still be challenging. However, good long-term outcome can be achieved if the initial postoperative phase is overcome.
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Affiliation(s)
- Angelika Weber
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Birgit Donner
- Division of Pediatric Cardiology, University Children's Hospital Basel, Basel, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Stefano Di Bernardo
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Daniel Trachsel
- Division of Pediatric Pulmonology, University Children's Hospital Basel, Basel, Switzerland
| | - Kishore Sandu
- Airway Unit, Service of Otorhinolaryngology, University Hospital Lausanne, Lausanne, Switzerland
| | - Nicole Sekarski
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
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34
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Congenital tracheal stenosis associated with left pulmonary artery sling accompanied by tracheal diverticula: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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35
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Lee JW, Printz BF, Hegde SR, Vargas LA, Sun HY. Double trouble: fetal diagnosis of a pulmonary artery sling and vascular ring. Clin Case Rep 2016; 4:1187-1190. [PMID: 27980760 PMCID: PMC5134211 DOI: 10.1002/ccr3.733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022] Open
Abstract
Left pulmonary artery slings and vascular rings are rare congenital anomalies definable by fetal echocardiography. Left pulmonary artery slings are associated with high respiratory morbidity and mortality. Prenatal diagnosis of a left pulmonary artery sling should prompt delivery planning for postnatal management at a pediatric tertiary care center.
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Affiliation(s)
- Jesse W Lee
- Division of Pediatric Cardiology Rady Children's Hospital University of California, San Diego San Diego California USA
| | - Beth F Printz
- Division of Pediatric Cardiology Rady Children's Hospital University of California, San Diego San Diego California USA
| | - Sanjeet R Hegde
- Division of Pediatric Cardiology Rady Children's Hospital University of California, San Diego San Diego California USA
| | - Lisa A Vargas
- Division of Pediatric Cardiology Rady Children's Hospital University of California, San Diego San Diego California USA
| | - Heather Y Sun
- Division of Pediatric Cardiology Rady Children's Hospital University of California, San Diego San Diego California USA
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36
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Abstract
The term vascular ring refers to congenital vascular anomalies of the aortic arch system that compress the esophagus and trachea, causing symptoms related to those two structures. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum. Pulmonary artery sling is rare and these patients need to be carefully evaluated for frequently associated tracheal stenosis. Another cause of tracheal compression occurring only in infants is the innominate artery compression syndrome. In the current era, the diagnosis of a vascular ring is best established by CT imaging that can accurately delineate the anatomy of the vascular ring and associated tracheal pathology. For patients with a right aortic arch there recently has been an increased recognition of a structure called a Kommerell diverticulum which may require resection and transfer of the left subclavian artery to the left carotid artery. A very rare vascular ring is the circumflex aorta that is now treated with the aortic uncrossing operation. Patients with vascular rings should all have an echocardiogram because of the incidence of associated congenital heart disease. We also recommend bronchoscopy to assess for additional tracheal pathology and provide an assessment of the degree of tracheomalacia and bronchomalacia. The outcomes of surgical intervention are excellent and most patients have complete resolution of symptoms over a period of time.
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Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrada R Popescu
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Osama M Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 22, 225 E. Chicago Ave, Chicago, Illinois 60611; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey C Rastatter
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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37
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Ishii Y, Miyamoto T, Nakajima K, Tanaka K, Ikeda K, Inamura N, Takagi T, Kobayashi T, Arakawa H. Abnormal cardiac axis as a prenatal marker of left pulmonary artery sling. Pediatr Int 2016; 58:158-61. [PMID: 26607680 DOI: 10.1111/ped.12744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
Abstract
Left pulmonary artery sling (LPAS) is a rare vascular anomaly. The left pulmonary artery arises distally from the right pulmonary artery on the right side of the trachea and passes between the trachea and esophagus towards the left lung, compressing the lower trachea. LPAS is associated with congenital tracheal stenosis, which frequently requires early surgical intervention and has a poor prognosis due to severe airway obstruction after birth. Therefore, LPAS should be prenatally diagnosed to prepare for surgical intervention for tracheal stenosis. To the best of our knowledge, there are few reports on prenatal echocardiographic findings in LPAS. We report three prenatal cases of LPAS, which resulted in respiratory symptoms. We discuss fetal ultrasound findings and highlight the abnormal rotation of the fetal cardiac axis to the right as a useful sign in the prenatal screening of LPAS.
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Affiliation(s)
- Yoichiro Ishii
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan.,Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takashi Miyamoto
- Department of Cardiovascular Surgery, Gunma Children's Medical Center, Gunma, Japan
| | - Kimiko Nakajima
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Kensuke Tanaka
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Kentaro Ikeda
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Noboru Inamura
- Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Takeshi Takagi
- Department of Obstetrics, Gunma Children's Medical Center, Gunma, Japan
| | - Tomio Kobayashi
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Hirokazu Arakawa
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
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38
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Windsor A, Clemmens C, Jacobs IN. Rare Upper Airway Anomalies. Paediatr Respir Rev 2016; 17:24-8. [PMID: 26277452 DOI: 10.1016/j.prrv.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022]
Abstract
A broad spectrum of congenital upper airway anomalies can occur as a result of errors during embryologic development. In this review, we will describe the clinical presentation, diagnosis, and management strategies for a few select, rare congenital malformations of this system. The diagnostic tools used in workup of these disorders range from prenatal tests to radiological imaging, swallowing evaluations, indirect or direct laryngoscopy, and rigid bronchoscopy. While these congenital defects can occur in isolation, they are often associated with disorders of other organ systems or may present as part of a syndrome. Therefore workup and treatment planning for patients with these disorders often involves a team of multiple specialists, including paediatricians, otolaryngologists, pulmonologists, speech pathologists, gastroenterologists, and geneticists.
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Affiliation(s)
- Alanna Windsor
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
| | - Clarice Clemmens
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
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39
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Licari A, Manca E, Rispoli GA, Mannarino S, Pelizzo G, Marseglia GL. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol 2015; 50:511-24. [PMID: 25604054 DOI: 10.1002/ppul.23152] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/31/2014] [Accepted: 11/06/2014] [Indexed: 11/11/2022]
Abstract
Vascular rings are congenital anomalies that lead to variable degrees of respiratory problems or feeding difficulties by forming a complete or partial ring compressing the trachea, the bronchi, and the esophagus. The clinical diagnosis of vascular rings is often challenging for the pediatrician because the clinical manifestations are heterogeneous and nonspecific. Symptoms can vary from wheezing, stridor, dyspnea, and/or dysphagia to life-threatening conditions; however, they may not be present. The aim of this study is to review the recent literature on this subject and describe new developments in diagnostics and imaging.
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Affiliation(s)
- Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
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40
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Etesami M, Ashwath R, Kanne J, Gilkeson RC, Rajiah P. Computed tomography in the evaluation of vascular rings and slings. Insights Imaging 2014; 5:507-21. [PMID: 25008430 PMCID: PMC4141344 DOI: 10.1007/s13244-014-0343-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 11/26/2022] Open
Abstract
Vascular rings are congenital abnormalities of the aortic arch-derived vascular and ligamentous structures, which encircle the trachea and oesophagus to varying degrees, resulting in respiratory or feeding difficulties in children. A sling is an abnormality of the pulmonary arterial system resulting in airway compression. Although several imaging examinations are available for the evaluation of these anomalies, computed tomography (CT) has become the preferred test because of rapid acquisitions, making it feasible to perform the study without sedation or general anaesthesia. Furthermore, CT provides excellent spatial and temporal resolution, a wide field of view, multiplanar reconstruction capabilities and simultaneous evaluation of the airway. In this review, the current role and technique of CT in the evaluation of vascular rings are discussed. A brief discussion of the embryology of the aorta and branch vessels is followed by discussion and illustration of common and some uncommon vascular rings along with critical information required by surgeons. Teaching Points • Computed tomography is valuable in the evaluation of vascular rings.• Due to variable clinical and imaging presentations, diagnosis of vascular rings is often challenging.• Laterality of the arch is critical in surgical management.
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Affiliation(s)
- M. Etesami
- Cardiothoracic Imaging Section, Radiology, University Hospital of Cleveland, Case Western Reserve School of Medicine, Cleveland, OH USA
| | - R. Ashwath
- Department of Pediatric Cardiology, Rainbow Babies and Children’s Hospital, Cleveland, OH USA
| | - J. Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - R. C. Gilkeson
- Cardiothoracic Imaging Section, Radiology, University Hospital of Cleveland, Case Western Reserve School of Medicine, Cleveland, OH USA
| | - P. Rajiah
- Cardiothoracic Imaging Section, Radiology, University Hospital of Cleveland, Case Western Reserve School of Medicine, Cleveland, OH USA
- Cardiothoracic Imaging Section, Department of Radiology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106 USA
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41
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Sling pulmonar de diagnóstico casual. An Pediatr (Barc) 2014; 80:267-8. [DOI: 10.1016/j.anpedi.2013.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 11/20/2022] Open
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42
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Hraska V, Photiadis J, Haun C, Schindler E, Schneider M, Murin P, Asfour B. Pulmonary artery sling with tracheal stenosis. Multimed Man Cardiothorac Surg 2014; 2009:mmcts.2008.003343. [PMID: 24412825 DOI: 10.1510/mmcts.2008.003343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary artery sling (PAS) is a rare congenital heart disease in which the left pulmonary artery (LPA) originates from the right pulmonary artery (RPA) and encircles the distal trachea and right mainstem bronchus as it courses between the trachea and esophagus. Typically, patients with PAS have some respiratory symptoms, either due to external tracheal compression that can be corrected by relief of the sling mechanism, or due to severe diffuse tracheal stenosis with complete rings (ring-sling complex). The diagnosis of PAS is optimally made by echocardiography, while bronchoscopy is the key to the assessment of tracheal stenosis. Diagnosis is indication for surgery. Repair using a strategy of median sternotomy, cardiopulmonary bypass, division of the LPA and reimplantation into the main pulmonary artery (MPA), and simultaneous tracheal repair takes preference. Tracheal repair should be considered only in clinically symptomatic patients. The techniques of free tracheal autograft plasty or slide tracheoplasty offer promising results, and the choice of tracheal reconstruction should be guided by the clinical experience of the surgeon. Coexisting intracardiac pathologies are repaired at the same time. Postoperative care requires close multidisciplinary effort to achieve the best long-term result.
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Affiliation(s)
- Viktor Hraska
- Department of Pediatric Cardiac Surgery, German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin, Arnold Janssen Str. 29, 53757 Sankt Augustin, Germany
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43
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Joshi A, Agarwal S, Aggarwal SK, Datt V, Sethi GR, Satsangi DK. Single Stage Repair of Tetralogy of Fallot Associated With Left Pulmonary Artery Sling and Tracheal Stenosis. J Card Surg 2013; 28:595-8. [DOI: 10.1111/jocs.12192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ajeya Joshi
- Department of Cardiovascular and Thoracic Surgery; G B Pant Hospital; New Delhi India
| | - Saket Agarwal
- Department of Cardiovascular and Thoracic Surgery; G B Pant Hospital; New Delhi India
| | | | - Vishnu Datt
- Department of Anesthesiology; G B Pant Hospital; New Delhi India
| | - G. R. Sethi
- Department of Pediatrics; Maulana Azad Medical College; New Delhi India
| | - Deepak Kumar Satsangi
- Department of Cardiovascular and Thoracic Surgery; G B Pant Hospital; New Delhi India
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44
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Yong MS, d'Udekem Y, Brizard CP, Robertson T, Robertson CF, Weintraub R, Konstantinov IE. Surgical management of pulmonary artery sling in children. J Thorac Cardiovasc Surg 2012; 145:1033-1039. [PMID: 22698556 DOI: 10.1016/j.jtcvs.2012.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 04/12/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Pulmonary artery (PA) sling is a rare vascular anomaly associated with congenital tracheal stenosis. The natural history is poor and these patients often require early surgical intervention. We describe our experience with repair of this condition. METHODS From 1984 to 2011, 21 patients with PA sling underwent repair at the Royal Children's Hospital (median age, 5.9 months). PA sling was associated with compression of the trachea in all patients. Tracheal surgery was required in 12 (57.1%) patients. All patients had an echocardiogram, and concomitant repair of coexisting cardiac anomalies was performed in 6 (28.6%, 6/21) patients. RESULTS Operative mortality was 14.3% (3/21), occurring at 19 days, 4.4 months, and 5 months after surgery. Operative mortality for the first 10 years was 22.2% (1984-1993; 2/9), the next 10 years was 14.3% (1994-2003; 1/7), and 0% for the most recent 7 years (2004-2011; 0/5). All deaths occurred in patients requiring tracheal repair (25%, 3/12). No deaths have occurred since 2004 with introduction of the slide tracheoplasty technique. One (5.6%, 1/18) late death occurred at 8 months after repair. After tracheal repair, intervention for excessive granulations and tracheomalacia was necessary in 6 (50%, 6/12) patients. Median follow-up was 8 years (mean, 8.6 ± 6.4 years; range, 5 months to 20.6 years), and all survivors (100%, 17/17) remain asymptomatic. CONCLUSIONS Children with PA sling who do not require tracheal surgery have excellent outcomes. Mortality is determined by the need for tracheal surgery. However, with the advent of the slide tracheoplasty technique, mortality can be reduced. Survival beyond 1 year after surgery offers excellent prognosis.
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Affiliation(s)
- Matthew S Yong
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Colin F Robertson
- Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Robert Weintraub
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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Berdon WE, Muensterer OJ, Zong YMM, Backer CL. The triad of bridging bronchus malformation associated with left pulmonary artery sling and narrowing of the airway: the legacy of Wells and Landing. Pediatr Radiol 2012; 42:215-9. [PMID: 22002862 DOI: 10.1007/s00247-011-2273-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 10/16/2022]
Abstract
Although noted in the 19th century, it was not until 1938 that Scheid published the combination of left pulmonary artery sling and narrowing of the airway due to annular tracheal cartilages. Unaware of these prior descriptions, and without a precise preoperative diagnosis, Willis Potts in Chicago performed the first successful sling repair in 1953. In 1976, Cohen and Landing described Scheid's combination of left pulmonary artery sling and stenosis caused by complete tracheal rings, and the term "ring-sling complex" was introduced by Berdon in 1984. Four years later, Wells and Landing noted characteristic tracheobronchial malformations associated with these lesions and proposed a classification that has been confirmed to be clinically relevant in recent cross-sectional imaging studies.
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Affiliation(s)
- Walter E Berdon
- Department of Radiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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46
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Backer CL, Russell HM, Kaushal S, Rastatter JC, Rigsby CK, Holinger LD. Pulmonary artery sling: Current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg 2012; 143:144-51. [DOI: 10.1016/j.jtcvs.2011.09.038] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/30/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022]
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Pierron C, Sigal-Cinqualbre A, Lambert V, Le Bret E. Left pulmonary artery sling with right lung aplasia. J Pediatr Surg 2011; 46:2190-4. [PMID: 22075357 DOI: 10.1016/j.jpedsurg.2011.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/26/2011] [Accepted: 07/27/2011] [Indexed: 11/16/2022]
Abstract
We report 2 cases of right pulmonary aplasia with left pulmonary artery sling responsible for severe respiratory symptoms. Repositioning of the left pulmonary artery without tracheal surgery was successful in both patients. The postoperative course was simple, and the outcome was favorable at last follow-up (after 2 years and 3 months, respectively). Computed tomography provided an accurate diagnostic evaluation that helped to choose the best surgical technique.
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Affiliation(s)
- Charlotte Pierron
- Département des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 92350 Le Plessis Robinson, France
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48
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Russell HM, Backer CL. Pediatric Thoracic Problems: Patent Ductus Arteriosus, Vascular Rings, Congenital Tracheal Stenosis, and Pectus Deformities. Surg Clin North Am 2010; 90:1091-113. [DOI: 10.1016/j.suc.2010.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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49
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Backer CL, Holinger LD. A History of Pediatric Tracheal Surgery. World J Pediatr Congenit Heart Surg 2010; 1:344-63. [DOI: 10.1177/2150135110381602] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tracheal stenosis in children is primarily caused by congenital complete cartilage tracheal rings. These infants present with severe respiratory distress early in life. The purpose of this review is to examine the history of surgical intervention for infants and children with congenital tracheal stenosis. Most of the significant advances in the surgical treatment of patients with congenital tracheal stenosis have occurred over the past 50 years. The highlights of the historical events include the first pulmonary artery sling repair (1953), tracheal resection (1958), cartilage tracheoplasty (1981), pericardial tracheoplasty (1982), slide tracheoplasty (1989), homograft tracheoplasty (1994), and tracheal autograft (1996). The results of surgical intervention on patients with congenital tracheal stenosis have steadily improved, particularly during the past 20 years. Most successful centers are using cardiopulmonary bypass, simultaneous repair of associated pulmonary artery sling and cardiac anomalies, and the current procedure of choice—slide tracheoplasty. During the past 50 years, significant advances have been made in the care of infants with congenital tracheal stenosis. The outlook for these children is currently quite good, and successful outcomes are particularly evident at institutions with a careful multidisciplinary approach to these patients.
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Affiliation(s)
- Carl L. Backer
- Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lauren D. Holinger
- Division of Otolaryngology, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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50
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Maldonado JA, Henry T, Gutiérrez FR. Congenital Thoracic Vascular Anomalies. Radiol Clin North Am 2010; 48:85-115. [DOI: 10.1016/j.rcl.2009.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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