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Carlson L, Haider M, Liu H, Baird C, Mayer JE, Nathan M. Left Pulmonary Artery Sling: Postoperative Outcomes for Patients at a Single Center. World J Pediatr Congenit Heart Surg 2021; 12:715-727. [PMID: 34846972 DOI: 10.1177/21501351211040741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Left pulmonary artery (LPA) sling is a rare anomaly characterized by the origin of the LPA from the right pulmonary artery with a course between the trachea and esophagus. It is often associated with airway and cardiac anomalies. METHODS This is a retrospective case series of consecutive patients who underwent LPA sling repair (LPASR) at a tertiary care center over a 35-year period with a focus on tracheal and/or LPA reinterventions and survival. RESULTS Between June 1983 and July 2018, 42 patients were identified: isolated LPASR was performed in 16 (38%), LPASR/intracardiac repair in 10 (24%), and LPASR/tracheal repair in 16 (38%). There were 5 (12%) in-hospital and 4 (10%) late deaths. Survival rates (15 years) were as follows: 100% (isolated LPASR), 65% (concomitant intracardiac repair), and 52% (concomitant tracheal surgery). Preoperative intensive care unit (ICU) hospitalization was associated with future intervention on the LPA/trachea (61%, 11/18). The median distribution of blood flow to the left lung post-index surgery was 38%. Freedom from isolated LPA intervention was 100% after isolated LPASR, 93% after LPASR/tracheal surgery, and 69% after LPASR/intracardiac repair. Freedom from isolated tracheal intervention was 92% after isolated LPASR, 73% after LPASR/tracheal surgery, and 78% after LPASR/intracardiac repair. CONCLUSIONS ICU hospitalization prior to index surgery may indicate the severity of associated cardiac/tracheal abnormalities as this is associated with increased morbidity and mortality. Patients who underwent LPASR/intracardiac surgery were more likely to undergo isolated LPA intervention and those who underwent LPASR/tracheal surgery were more likely to undergo isolated tracheal intervention.
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Affiliation(s)
| | - Mahwish Haider
- 1862Boston Children's Hospital.,522567Amsterdam University Medical Centre
| | - Hua Liu
- 1862Boston Children's Hospital
| | - Christopher Baird
- 1862Boston Children's Hospital.,1811Harvard Medical School, Boston, MA
| | - John E Mayer
- 1862Boston Children's Hospital.,1811Harvard Medical School, Boston, MA
| | - Meena Nathan
- 1862Boston Children's Hospital.,1811Harvard Medical School, Boston, MA
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Hamisa M, Elsharawy F, Elsherbeny W, Bayoumy S. Comparative study between multi-detector computed tomography and echocardiography in evaluation of congenital vascular rings. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Manal Hamisa
- Radiodiagnosis Departments, Faculty of Medicine, Tanta University, Egypt
| | - Fatma Elsharawy
- Radiodiagnosis Departments, Faculty of Medicine, Tanta University, Egypt
| | - Wafaa Elsherbeny
- Cardiology Departments, Faculty of Medicine, Tanta University, Egypt
| | - Suzan Bayoumy
- Cardiology Departments, Faculty of Medicine, Tanta University, Egypt
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Fukuda H, Imataka G, Drago F, Maeda K, Yoshihara S. 3-Dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female. Exp Ther Med 2017; 14:2600-2602. [PMID: 28962200 PMCID: PMC5609306 DOI: 10.3892/etm.2017.4821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
We report a case of a 10-year-old female patient who survived ring-sling complex without surgery. The patient had congenital wheezing from the neonatal period and was treated after a tentative diagnosis of infantile asthma. The patient suffered from allergy and was hospitalized several times due to severe wheezing, and when she was 22 months old, she was diagnosed with ring-sling complex. We used a segmental 4 mm internal diameter of the trachea for 3-dimensional computed tomography (3D-CT). Bronchial asthma is considered an exacerbating factor in infantile period and frequently required treatment with bronchodilator. After the age of 10, the patient had recurrent breathing difficulties during physical activity and during night time, and this condition was assessed to be related to the pressure from the blood vessel on the ring. We repeated the 3D-CT evaluation later and discovered that the internal diameter of the trachea had grown to 5 mm. Eventually, patient's breathing difficulties disappeared after the treatment of bronchial asthma and restriction of physical activities. Our patient remained in stable condition without undergoing any surgical procedures even after she passed the age of 10.
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Affiliation(s)
- Hironobu Fukuda
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - George Imataka
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Pediatric Cardiology and Cardiac Arrhythmia Complex Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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4
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Semiz-Oysu A, Basaran I, Barutca H, Bukte Y. Anomalous left pulmonary artery without sling formation. Pediatr Cardiol 2014; 34:1928-31. [PMID: 22878809 DOI: 10.1007/s00246-012-0463-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/16/2012] [Indexed: 11/27/2022]
Abstract
A case of aberrant left pulmonary artery originating from the right pulmonary artery resembling pulmonary artery sling malformation, but without true sling formation, is presented. Anomalous left pulmonary artery was accompanied with long-segment proximal tracheal stenosis and other congenital malformations typically associated with PAS complex. The anomalous pulmonary artery passed anterior to the trachea; therefore, no true sling was formed. Because no airway compression by the aberrant left pulmonary artery was detected, the proximal tracheal stenosis was thought to be primary.
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Affiliation(s)
- Aslihan Semiz-Oysu
- Department of Radiology, Umraniye Training and Research Hospital, Ümraniye Eğitim ve Araştırma Hastanesi, Adem Yavuz Cad. No: 1, Ümraniye, Istanbul, 34766, Turkey,
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Developmental aortic arch anomalies in infants and children assessed with CT angiography. AJR Am J Roentgenol 2012; 198:W466-74. [PMID: 22528928 DOI: 10.2214/ajr.11.6982] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review the normal anatomy of the aortic arch and the most common variations of congenital aortic arch anomalies using low-radiation-dose, defined as a dose-length product of 7-15 mGy × cm, MDCT angiography. CONCLUSION Radiologists should be prepared to fully describe congenital aortic arch anomalies; recognize them on CT angiography, especially the presence or absence of vascular rings or aberrant arteries; and explain their association with the trachea and esophagus.
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Omran E, El-Rakhawy M, Elgaber NA. Vascular ring: Role of multidetector CT with 3D reconstruction in diagnosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2011.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Lee EY, Greenberg SB, Boiselle PM. Multidetector computed tomography of pediatric large airway diseases: state-of-the-art. Radiol Clin North Am 2011; 49:869-93. [PMID: 21889013 DOI: 10.1016/j.rcl.2011.06.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Advances in multidetector computed tomography (MDCT) technology have given rise to improvements in the noninvasive and comprehensive assessment of the large airways in pediatric patients. Superb two-dimensional and three-dimensional reconstruction MDCT images have revolutionized the display of large airways and enhanced the ability to diagnose large airway diseases in children. The 320-MDCT scanner, which provides combined detailed anatomic and dynamic functional information assessment of the large airways, is promising for the assessment of dynamic large airway disease such as tracheobronchomalacia. This article discusses imaging techniques and clinical applications of MDCT for assessing large airway diseases in pediatric patients.
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Affiliation(s)
- Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Children's Hospital Boston and Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA.
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Abstract
Distinctive imaging findings are present when the left pulmonary artery (LPA) arises from the right pulmonary artery and forms a sling around the airway passing between airway and esophagus to reach the left lung. It is important to recognize the 2 distinct types of pulmonary sling. The less complex type I is associated with tracheobronchomalacia and is often managed successfully by LPA reimplantation. The more common and more complex type II is strongly associated with long segment tracheal stenosis. Appropriate management needs to address the airway abnormality in addition to the aberrant LPA. Both types, especially type II, are associated with cardiovascular, pulmonary, and other abnormalities that also need to be considered in therapeutic decisions. The role of imaging is to identify, define, and display the relevant anatomic relationships to facilitate appropriate management. Recent surgical advances have increased the likelihood of success of surgical correction of long segment airway stenosis.
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Affiliation(s)
- Beverley Newman
- Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford University, Stanford, CA 94305, USA.
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Kagadis GC, Panagiotopoulou EC, Priftis KN, Anthracopoulos MB. Xihong Hu, Guoying Huang, Mier Pa. Multidetector computed tomography for assessing a pulmonary artery sling in a pediatric patient. Pediatr Cardiol 2008; 29:1006-1007. Pediatr Cardiol 2009; 30:570. [PMID: 19294460 DOI: 10.1007/s00246-009-9399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 02/02/2009] [Indexed: 11/26/2022]
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Di Sessa TG, Di Sessa P, Gregory B, Vranicar M. The Use of 3D Contrast-Enhanced CT Reconstructions to Project Images of Vascular Rings and Coarctation of the Aorta. Echocardiography 2009; 26:76-81. [DOI: 10.1111/j.1540-8175.2008.00739.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nagata H, Yamamura K, Watanabe M, Imoto Y, Sese A, Joo K. Multislice spiral computed tomography in an infant with pulmonary arterial sling compressing the trachea. J Pediatr 2008; 153:870. [PMID: 19014825 DOI: 10.1016/j.jpeds.2008.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 04/15/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Hazumu Nagata
- The Department of Pediatrics, Kyushu Koseinenkin Hospital, Fukuoka, 806-8501, Japan
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Koletsis EN, Kalogeropoulou C, Prodromaki E, Kagadis GC, Katsanos K, Spiropoulos K, Petsas T, Nikiforidis GC, Dougenis D. Tumoral and non-tumoral trachea stenoses: evaluation with three-dimensional CT and virtual bronchoscopy. J Cardiothorac Surg 2007; 2:18. [PMID: 17430592 PMCID: PMC1950485 DOI: 10.1186/1749-8090-2-18] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Accepted: 04/12/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the ability of 3D-CT and virtual bronchoscopy to estimate trachea stenosis in comparison to conventional axial CT and fiberoptic bronchoscopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures. METHODS Spiral CT was performed in 16 patients with suspected tracheal stenoses and in 5 normal subjects. Tracheal stenoses due to an endoluminal neoplasm were detected in 13 patients, whilst post-intubation tracheal stricture was observed in the other 3 patients. Multiplanar reformatting (MPR), volume rendering techniques (VRT) and virtual endoscopy (VE) for trachea evaluation were applied and findings were compared to axial CT and fiberoptic bronchoscopy. The accuracy of the procedure in describing the localization and degree of stenosis was tested by two radiologists in a blinded controlled trial. RESULTS The imaging modalities tested showed the same stenoses as the ones detected by flexible bronchoscopy and achieved accurate and non-invasive morphological characterization of the strictures, as well as additional information about the extraluminal extent of the disease. No statistically significant difference was observed between the bronchoscopic findings and the results of axial CT estimations (P = 1.0). No statistically significant differences were observed between bronchoscopic findings and the MPR, VRT and VE image evaluations (P = 0.705, 0.414 and 0.414 respectively). CONCLUSION CT and computed generated images may provide a high fidelity, noninvasive and reproducible evaluation of the trachea compared to bronchoscopy. They may play a role in assessment of airway patency distal to high-grade stenoses, and represent a reliable alternative method for patients not amenable to conventional bronchoscopy.
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Affiliation(s)
- Efstratios N Koletsis
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Greece
- Department of Medical Physics, School of Medicine, University of Patras, Greece
| | | | - Eleni Prodromaki
- Department of Pneumonology, School of Medicine, University of Patras, Greece
| | - George C Kagadis
- Department of Pneumonology, School of Medicine, University of Patras, Greece
| | | | | | - Theodore Petsas
- Department of Radiology, School of Medicine, University of Patras, Greece
| | | | - Dimitris Dougenis
- Department of Cardiothoracic Surgery, School of Medicine, University of Patras, Greece
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