Ann Thorac Surg 2009;87:965. doi:10.1016/j.athoracsur.2008.11.076
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Partial Form of a Pulmonary Artery Sling
Atsushi Tateishi, MD*,
Masaaki Kawada, MD, PhD
Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
* Address correspondence to Dr Tateishi, Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan (Email: atateishi{at}jichi.ac.jp).
A 4-month-old infant with dyspnea was referred to our hospital. Two-dimensional echocardiography disclosed a partial atrioventricular septal defect, mild atrioventricular valve regurgitation, and an anomalous left pulmonary artery from the right pulmonary artery. A volume-rendered computed tomography scan showed a partial form of a pulmonary artery sling, with an anomalous left lower pulmonary artery from the right pulmonary artery, and tracheal stenosis (Fig 1). The anomalous left lower pulmonary artery coursed behind the trachea to reach the left hilum and impinged on the long-segment lower trachea with cartilaginous rings.
Concomitant surgical repair of cardiovascular and tracheal anomalies was done under cardiopulmonary bypass support at age 8 months after the patient underwent 4 months of respiratory care. After intracardiac repair of the partial atrioventricular septal defect, the anomalous left lower pulmonary artery was detached from the right pulmonary artery and pulled through into the left side of the cardiac base. It was then spatulated and reimplanted to the main pulmonary artery at the site of the ductal ligament.
The patient's postoperative course was complicated by restenosis of the distal end of the tracheal anastomosis with granulation tissue. This was relieved by endoscopic removal.
There are only a few reports of a partial anomalous origin of the left pulmonary artery that has caused a serious airway obstruction [1–4]. This report presents a rare case of a partial anomalous left pulmonary artery with airway obstruction, a partial form of a pulmonary artery sling.
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References
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- Bamman JL, Ward BH, Woodrum DE. Aberrant left pulmonary artery Chest 1977;72:67-71.[Abstract/Free Full Text]
- Kock A, Hofbeck M, Gerling S, Buheitel G, Singer H. Partial anomalous origin of the left pulmonary artery Z Kardiol 2000;89:118-121.[Medline]
- Fountain-Dommer RR, Shirali GS, Wiles HB, Larsen RL. Noninvasive diagnosis of partial anomalous left pulmonary artery J Am Soc Echocardiogr 2001;14:745-746.[Medline]
- Ge S, DeGroff CG, Knudson O, Strain J, Chan KC. Noninvasive assessment of pseudo-pulmonary artery sling by echocardiography and computerized tomography Circulation 2001;103:e115-e116.[Medline]
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