Surgical indication for congenital tracheal stenosis complicated by pulmonary artery sling

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.

Incidence and risk factor of vocal cord paralysis following slide tracheoplasty for congenital tracheal stenosis: a retrospective observational study

“…It is often associated with CTS (the so-called ring-sling complex), with an incidence reported of about 50-65% of CTS cases. 20 In the present study, CTS was complicated by PA sling at a rate of 53.6%, which is similar to the results of previous reports. Patients with PA sling undergo reimplantation of the aberrant left PA to the main PA to relieve extrinsic airway compression.…”

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

“…The options of surgical procedures for PAS are mainly based on the severity of combined tracheobronchial malformations. Although LPA reimplantation alone is preferable for type I cases, the treatment strategy for type II cases is still under debate due to the lack of sufficient evidence (7). Most authors suggest that LPA reimplantation plus simultaneous tracheoplasty should be performed in patients presenting moderate or more severe clinical symptoms (19)(20)(21).…”

“…Indeed, it is difficult to predict, before surgery, if the respiratory symptoms in patients with PAS and congenital tracheal stenosis (CTS) have to be ascribed to one, the other or, to the combination of both. Hence, in addition to clinical findings, the internal diameter and length of CTS were reported as more reliable indicators for surgical intervention, wherein a tracheal diameter <3.7 mm and/or a diameter/length ratio <5.9 were supposed to be an indication for tracheoplasty ( 4 , 7 , 8 ). In our case, on account of severe stenosis (3.6 mm at the narrowest diameter) extending to all the trachea seen on bronchoscopy, it was impossible to assume that the repair of PAS alone would be able to resolve her condition.…”

“…Except for the presence or absence of clinical symptoms, the extent of tracheal stenosis is another determining factor for the choice of intervention timing since clinical symptoms might not correspond well with the degree of stenosis ( 6 , 7 ). Notably, most clinicians, particularly those who are not cardiologists or respiratory specialists, would be not aware that the tracheal stenosis is not only related to the extrinsic local impression of the aberrant pulmonary artery on the trachea but also concomitant maldevelopment of the bronchial tree, which is often observed in type II of PAS.…”

Slide Tracheoplasty for Congenital Tracheal Stenosis Repair: A Systematic Review and Meta‐Analysis

“…CTS is often observed in conjunction with cardiovascular anomalies, particularly pulmonary artery sling (PAS). 2 Concomitant repair of CTS with cardiovascular anomalies has frequently been reported. 3 During the last three decades, surgical reconstruction of CTS has been performed with the use of numerous techniques including resection and end-to-end anastomosis, slide tracheoplasty, and augmentation with pericardial, rib cartilage, or autograft patch.…”