eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Pulmonary Artery Sling: Follow-up

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
Contributor Information and Disclosures

Updated: Aug 26, 2008

Follow-up

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.

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.

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.

Deterrence/Prevention

  • No preventive measures are known.

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose stridor in a young infant
  • Late diagnosis of pulmonary artery sling
  • Failure to monitor patients postoperatively for persistent airway obstruction
 


More on Pulmonary Artery Sling

Overview: Pulmonary Artery Sling
Differential Diagnoses & Workup: Pulmonary Artery Sling
Treatment & Medication: Pulmonary Artery Sling
Follow-up: Pulmonary Artery Sling
References
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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. Potts W, Holinger P. Anomalous left pulmonary artery causing obstruction to the right main stem bronchus. JAMA. 1954;155:1409.

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

  5. 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].

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

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

  8. 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].

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

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Further Reading

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Keywords

pulmonary artery sling, vascular ring, vascular sling, emphysema, atelectasis, atrial septal defect, patent ductus arteriosus, ventricular septal defect, left superior vena cava, imperforate anus, Hirschsprung disease, biliary atresia, genitourinary defects, airway obstruction, stridor, respiratory distress, cyanosis, pneumonia

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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.

Medical Editor

Ira H Gessner, MD, Professor Emeritus, Pediatric Cardiology
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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert 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.

 
 
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