Division of Cardiovascular Thoracic Surgery, Children's Memorial Hospital, Chicago, Ill 60614, USA.
J Thorac Cardiovasc Surg. 2012 Jan;143(1):144-51. doi: 10.1016/j.jtcvs.2011.09.038. Epub 2011 Nov 3.
We have used cardiopulmonary bypass with left pulmonary artery reimplantation for pulmonary artery sling repair since 1985. This review presents our current results with this technique, emphasizing the importance of diagnosis and treatment of frequently associated tracheal stenosis.
Since 1985, 34 patients have undergone pulmonary artery sling repair using a median sternotomy and cardiopulmonary bypass. Age ranged from 9 days to 43 years (mean 2.1 ± 7.5 years, median 0.2 years). Twenty-seven patients (79%) had tracheal stenosis secondary to complete cartilage tracheal rings. All patients had preoperative airway imaging with rigid bronchoscopy, and since 2000 all patients have had computed tomography imaging of the chest with 3-dimensional reconstruction (n = 14). Tracheal repair has included pericardial patch tracheoplasty (n = 7), tracheal autograft (n = 10), tracheal resection (n = 4), and slide tracheoplasty (n = 5). All patients had an echocardiogram, and cardiac lesions repaired simultaneously included atrial septal defect (4), tetralogy of Fallot (2), and ventricular septal defect (1). One patient had a severely hypoplastic right lung, and 3 patients had an absent right lung. In these patients, the left pulmonary artery was translocated anterior to the trachea. In all other patients, the left pulmonary artery was reimplanted into the main pulmonary artery.
There have been no early deaths or complications related to the use of cardiopulmonary bypass. Median hospital stay was 24 days. There have been 4 late deaths. Two late deaths were the result of complications of tracheal surgery (1 pericardial patch [6 months postoperatively] and 1 autograft [1.7 years postoperatively]). One child died of biliary atresia (0.2 years postoperatively), and 1 child died of pneumonia (5.8 years postoperatively). All recent tracheal stenosis repairs have been with slide tracheoplasty. All left pulmonary arteries are patent with a mean percent flow by perfusion scan of 41% ± 13%. Older patients (n = 2) have noted a significant improvement in exercise tolerance.
Pulmonary artery sling is best repaired with median sternotomy, cardiopulmonary bypass, and left pulmonary artery reimplantation. This resulted in uniformly patent left pulmonary arteries in all patients. Preoperative computed tomography imaging, echocardiography, and bronchoscopy are essential for precise operative planning. The frequently associated tracheal stenosis is best repaired with slide tracheoplasty.
自 1985 年以来，我们一直使用体外循环和左肺动脉再植入术治疗肺动脉吊带。本研究介绍了我们目前使用该技术的结果，强调了诊断和治疗常合并的气管狭窄的重要性。
自 1985 年以来，34 例患者接受了经正中胸骨切开术和体外循环的肺动脉吊带修复术。年龄为 9 天至 43 岁（平均 2.1±7.5 岁，中位数 0.2 岁）。27 例（79%）患者因完全软骨气管环导致气管狭窄。所有患者均行术前气道影像学检查，包括刚性支气管镜检查，自 2000 年以来，所有患者均行胸部 CT 检查并进行三维重建（n=14）。气管修复包括心包补片气管成形术（n=7）、气管自体移植（n=10）、气管切除术（n=4）和滑动气管成形术（n=5）。所有患者均行超声心动图检查，同时修复的心脏病变包括房间隔缺损（4）、法洛四联症（2）和室间隔缺损（1）。1 例患者右肺严重发育不良，3 例患者右肺缺如。在这些患者中，左肺动脉被移位于气管前方。在所有其他患者中，左肺动脉被再植入主肺动脉。
无体外循环相关的早期死亡或并发症。中位住院时间为 24 天。共有 4 例晚期死亡。2 例晚期死亡是气管手术并发症的结果（1 例心包补片[术后 6 个月]，1 例自体移植[术后 1.7 年]）。1 例患儿因胆道闭锁（术后 0.2 年）死亡，1 例患儿因肺炎（术后 5.8 年）死亡。最近的所有气管狭窄修复均采用滑动气管成形术。所有左肺动脉均通畅，灌注扫描平均血流百分比为 41%±13%。年龄较大的患者（n=2）运动耐量显著改善。
肺动脉吊带最好通过正中胸骨切开术、体外循环和左肺动脉再植入术进行修复。这使得所有患者的左肺动脉均保持通畅。术前 CT 成像、超声心动图和支气管镜检查对于精确的手术规划至关重要。常合并的气管狭窄最好采用滑动气管成形术进行修复。
