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PulmonaryArterySlingandInnominate
ArteryCompressionSyndrome
PulmonaryArterySling
Earlyrecognitionisimportant.Generalsupportiverespiratorycareshouldbe
givenbeforeproceedingtosurgery.Respiratoryinfectionmaybedifficultto
clearcompletelybeforesurgerybecauseofpersistentretentionofsecretions.The
firstsurgicalrepairofpulmonaryarteryslingwasbyWillisJ.PottsatChildren's
MemorialHospitalin1954.131Earlyexperiencewithsurgicalrepairof
pulmonaryarteryslingwasassociatedwithsignificantoperativemortality,50but
smallsingleinstitutionserieshavebeenreported.132Earlyattritionwasrelatedto
patientsrequiringconcomitantsurgicalinterventionfortrachealstenosis.The
incidenceofcongenitaltrachealstenosiswithleftpulmonaryarteryslinghas
beenreportedtobeashighas50%to65%.75,133Fiberopticbronchoscopyto
assessforthepresenceofcompletetrachealringsismandatorywhenthe
diagnosisofleftpulmonaryarteryslingismade.Concomitanttrachealrepairhas
beenrecommendedinpatientswhodemonstratecompletetrachealrings.134
However,someauthorsadvocatereimplantationoftheleftpulmonaryartery
alone,eveninthepresenceofcompletetrachealrings,ifthediameterofthe
tracheaisgreaterthan3mm135oriftheratioofstenosislengthtototaltracheal
lengthishigh.136Echocardiographyshouldalsobedonebecauseofthe
associationofthislesionwithothercardiacdefects.137Thiswillallowcomplete
assessmentofallassociateddefectsandcarefulplanningofthesurgical
procedure.Therepairisapproachedviamediansternotomyandmostoftenuses
cardiopulmonarybypass.Thebypassstrategyisguidedbytheneedfor
interventiononthetracheaandthepresenceorabsenceofassociatedcardiac
defects.Theductusarteriosusisligatedanddivided.Anyintracardiacdefectsare
repairedfirstwithcardioplegicarrest.Theanomalousleftpulmonaryarteryand
tracheacanberepairedwiththeheartbeating.Thecourseoftheanomalousleft
pulmonaryarteryisbetweenthetracheaandesophagustothelefthilum.Once
transectedfromtheposteriorwalloftherightpulmonaryartery,itisdelivered
frombehindthetracheaandimplantedintotheleftsideofthemainpulmonary