Pulmonary Artery Sling Follow-up

  • Author: Stuart Berger, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Jan 19, 2012
 

Further Inpatient Care

  • Inpatient care in patients with pulmonary artery sling may be required for symptoms of airway obstruction and/or pneumonia.
  • After surgical repair, these same symptoms may persist, although they should improve over time.
Next

Further Outpatient Care

  • Close follow-up care after surgery is required.
  • Although airway symptoms should improve, follow patients closely, especially during times of upper respiratory infections.
  • Similarly, monitor this group of patients closely for the possibility of left pulmonary artery stenosis after reimplantation of the vessel. This can be noninvasively assessed with echocardiography but rarely may require follow-up pulmonary artery angiography.
Previous
Next

Transfer

  • Patients hospitalized with significant stridor, in whom a vascular ring or pulmonary artery sling is suspected, should be transferred to a facility that can provide pediatric cardiology and pediatric cardiovascular surgery services.
Previous
Next

Deterrence/Prevention

  • No preventive measures are known.
Previous
Next

Complications

  • Because of associated tracheomalacia, tracheal stenosis, and/or bronchial stenosis, postoperative symptoms of airway obstruction are common. Left pulmonary artery stenosis may occur and can be progressive.
Previous
Next

Prognosis

  • With early diagnosis and surgical correction, prognosis is good.
  • Surgical mortality is increased by coexisting tracheal or bronchial stenosis.
  • Surgical survivors may be free of significant symptoms at long-term follow-up; however, because many demonstrate some persistent airway obstruction, they should be closely observed for both airway as well as pulmonary artery complications.
Previous
Next

Patient Education

  • Parents should be educated about issues with regard to airway obstruction and tracheobronchial toilet. Patients in the immediate postoperative period still may be at risk during respiratory illnesses because of increased secretions. Over time, with healing and improvement of the tracheomalacia/tracheal stenosis, these symptoms should improve.
Previous
 
Contributor Information and Disclosures
Author

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Specialty Editor Board

Ira H Gessner, MD  Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References

  1. Sade RM, Rosenthal A, Fellows K, et al. Pulmonary artery sling. J Thorac Cardiovasc Surg. Mar 1975;69(3):333-46. [Medline].

  2. Loukanov T, Sebening C, Springer W, et al. Simultaneous management of congenital tracheal stenosis and cardiac anomalies in infants. J Thorac Cardiovasc Surg. Dec 2005;130(6):1537-41. [Medline].

  3. Newman B, Cho YA. Left Pulmonary Artery Sling-Anatomy and Imaging. Semin Ultrasound CT MR. Apr 2010;31(2):158-170. [Medline].

  4. Potts W, Holinger P. Anomalous left pulmonary artery causing obstruction to the right main stem bronchus. JAMA. 1954;155:1409.

  5. Backer CL, Russell HM, Kaushal S, Rastatter JC, Rigsby CK, Holinger LD. Pulmonary artery sling: Current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg. Jan 2012;143(1):144-51. [Medline].

  6. Freedom R, Culham J. The Angiography of Congenital Heart Disease. 1998.

  7. Grover FL, Norton JB Jr, Webb GE, et al. Pulmonary sling. Case report and collective review. J Thorac Cardiovasc Surg. Feb 1975;69(2):295-300. [Medline].

  8. Morrow R, Huhta J. Aortic arch and pulmonary artery anomalies. In: The Science and Practice of Pediatric Cardiology. 1990:1444-7.

  9. Niwayama G. Unusual vascular ring formed by the anomalous left pulmonary artery, with tracheal compression. Am Heart J. Mar 1960;59:454-61. [Medline].

  10. Semple MG, Bricker L, Shaw BN, Pilling DW. Left pulmonary artery sling presenting as unilateral echogenic lung on 20-week detailed antenatal ultrasound examination. Pediatr Radiol. Aug 2003;33(8):567-9. [Medline].

  11. Tesler UF, Balsara RH, Niguidula FN. Aberrant left pulmonary artery (vascular sling): report of five cases. Chest. Oct 1974;66(4):402-7. [Medline].

 
Previous
Next
 
Aberrant left pulmonary artery or pulmonary artery sling.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.