Phelan P D, Venables A W
Thorax. 1978 Feb;33(1):67-71. doi: 10.1136/thx.33.1.67.
An anomalous left pulmonary artery arising from a right pulmonary artery and passing between the trachea and oesophagus was seen in seven patients over a period of 20 years. All of them had main airway obstruction. Surgical division and re-anastomosis of the anomalous artery in front of the trachea produced an unsatisfactory result in the first two patients. The only surgical procedure undertaken in the subsequent five patients was division of a ligamentum arteriosum; this formed part of a compressing ring in one patient. Three patients, one of whom had associated tracheobronchial stenosis, became completely asymptomatic. Two others, both with tracheobronchial stenosis, still have symptoms; the older has shown considerable improvement, while the younger is only 7 months old. It is suggested that a more conservative approach to the management of this anomaly is justified. In patients with associated tracheobronchial stenosis, symptoms are most probably the result of that anomaly. Surgical division of the anomalous artery is unlikely to be beneficial, and death from postoperative complications frequently occurs. Surgical division of the anomalous artery in patients with extrinsic tracheal compression should be considered only if life is threatened, as spontaneous improvement can be anticipated. Recent advances in respiratory care should assist in the conservative management of distressed infants.
在20年的时间里，7例患者被发现有一条异常的左肺动脉发自右肺动脉并在气管与食管之间穿行。他们均有主气道梗阻。前两名患者对异常动脉在气管前方进行手术分离和重新吻合，结果不理想。随后5例患者仅进行了动脉导管韧带切断术；其中1例患者该韧带构成压迫环的一部分。3例患者完全无症状，其中1例伴有气管支气管狭窄。另外2例均有气管支气管狭窄，仍有症状；年龄较大的患者症状有明显改善，而年龄较小的患者仅7个月大。提示对这种异常情况采取更保守的处理方法是合理的。在伴有气管支气管狭窄的患者中，症状很可能是由该异常引起的。手术切断异常动脉不太可能有益，且术后并发症导致的死亡经常发生。对于气管外部受压的患者，仅在生命受到威胁时才应考虑手术切断异常动脉，因为可预期会有自然改善。呼吸护理方面的最新进展应有助于对病情危急的婴儿进行保守治疗。
