Diagnosis Of Pulmonary Artery Sling Research Articles

Pulmonary artery sling: A rare congenital anomaly masquerading as asthma in a one-year-old male patient

Pulmonary artery sling is a rare congenital vascular anomaly that results in the abnormal development of the left pulmonary artery. This case report describes a one-year-old male patient with a history of respiratory issues who was initially treated for suspected infantile asthma. However, further investigation revealed a diagnosis of pulmonary artery sling, a rare congenital vascular anomaly that can cause airway and esophageal compression. The patient underwent surgical treatment to correct the abnormality. This case emphasizes the importance of considering pulmonary artery sling as a potential diagnosis in patients with respiratory symptoms and highlights the need for prompt diagnosis and treatment to prevent potential complications.

Ring-sling complex association with pig bronchus: a pediatric case report

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

GW29-e1579 Echocardiographic Diagnosis of Pulmonary Artery Sling

The objective of this study was to analyze echocardiographic characteristics of Pulmonary Artery Sling (LPAS) and to explore the diagnostic value of transthoracic echocardiography. The echocardiagraphic characteristics of 7 patients with LPAS from 2012 to 2016 were analyzed retrospectively, and

Echocardiography in diagnosis of pediatric pulmonary artery sling

To evaluate the application of echocardiography in diagnosis of pediatric pulmonary artery sling. Twenty-five children diagnosed as pulmonary artery sling in the Children's Hospital, Zhejiang University School of Medicine from July 2012 to August 2017, and 50 healthy children(control group) were enrolled in the study. Echocardiography was performed in all subjects. The origins of the left pulmonary artery(LPA) and right pulmonary artery(RPA) were observed; the internal diameters of LPA, RPA and main pulmonary artery(MPA) were measured; and the ratios of LPA/MPA and RPA/MPA were calculated. The value of RPA/MPA and LPA/MPA in diagnosing pulmonary artery sling was evaluated by ROC curve. Echocardiography showed that the internal diameters of RPA were increased in all patients; while the LPA and blood flow signals in common pulmonary arterial bifurcation were not found in 24 cases, in whom the MPA was directly extended to the RPA, and the LPA was from the massive RPA. The ultrasound of one special case showed that there was no distinct bifurcation of MPA; the MPA walked to the right and then to the left with no change in the internal diameter. There were significant differences in RPA/MPA(0.50±0.05 vs. 0.71±0.15, t=7.06, P<0.01) and LPA/MPA(0.52±0.05 vs. 0.39±0.09, t=6.94, P<0.01) between controls and the patients. ROC curve analysis showed that the AUC of RPA/MPA and LPA/MPA in diagnosis of pulmonary artery sling were 0.90 and 0.89, respectively. When taking 0.60 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RPA/MPA in diagnosis of pulmonary artery sling were 79%, 100%, 100%, 91% and 93%, respectively. When taking 0.43 as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LPA/MPA in diagnosis of pulmonary artery sling were 71%, 96%, 89%, 87% and 88%, respectively. s Echocardiography can effectively diagnose pediatric pulmonary artery sling. The RPA/MPA ratio of 0.60 and the LPA/MPA ratio of 0.43 can be used as cutoff values for diagnosis.

GW28-e0332 Echocardiographic Diagnosis of Pulmonary Artery Sling

GW28-e0332 Echocardiographic Diagnosis of Pulmonary Artery Sling

Echocardiographic Diagnosis of Pulmonary Artery Sling

Echocardiographic Diagnosis of Pulmonary Artery Sling

Pulmonary artery sling with tracheal stenosis

Pulmonary artery sling (PAS) is a rare congenital heart disease in which the left pulmonary artery (LPA) originates from the right pulmonary artery (RPA) and encircles the distal trachea and right mainstem bronchus as it courses between the trachea and esophagus. Typically, patients with PAS have some respiratory symptoms, either due to external tracheal compression that can be corrected by relief of the sling mechanism, or due to severe diffuse tracheal stenosis with complete rings (ring-sling complex). The diagnosis of PAS is optimally made by echocardiography, while bronchoscopy is the key to the assessment of tracheal stenosis. Diagnosis is indication for surgery. Repair using a strategy of median sternotomy, cardiopulmonary bypass, division of the LPA and reimplantation into the main pulmonary artery (MPA), and simultaneous tracheal repair takes preference. Tracheal repair should be considered only in clinically symptomatic patients. The techniques of free tracheal autograft plasty or slide tracheoplasty offer promising results, and the choice of tracheal reconstruction should be guided by the clinical experience of the surgeon. Coexisting intracardiac pathologies are repaired at the same time. Postoperative care requires close multidisciplinary effort to achieve the best long-term result.

Definitive Diagnosis of Pulmonary Artery Sling in a Critically Ill Infant With High-Resolution Computed Tomography

A 3-month-old infant was transferred to our hospital for evaluation of a heart murmur associated with severe respiratory distress. At echocardiography, an aberrant origin of the left pulmonary artery was suspected (Figure 1, Movies I and II). Figure 1. Two-dimensional echocardiographic left parasternal short-axis view (left panel) and color Doppler mapping in high parasternal short-axis view (right panel). Please note that the left pulmonary (LPA) artery is only visualized on color Doppler mapping. Note the …

The imaging diagnosis of pulmonary artery sling

目的 评价肺动脉吊带的影像学诊断价值.方法 7例肺动脉吊带中5例做了心血管造影(ACG)(5例均做了MR检查,4例同时做了CT检查),2例仅做MR检查. 结果 7例肺动脉吊带病例中6例显示左肺动脉起始于右肺动脉远端分叉部,并绕过气管后方(4例有气管压迫征象,临床有气急、喘鸣的症状),另有1例为左下肺动脉起始于右肺动脉远端近分叉处,左上肺动脉起始正常.5例经手术证实.结论 ACG、造影增强磁共振血管造影(CE-MRA)、CT血管造影(CTA)为明确肺动脉吊带诊断的最佳方法,3种方法可互为补充.心血管造影选择性强,CE-MRA的三维成像显示肺动脉的走向较有优势;CTA可以同时显示气管和异常起源的左肺动脉之间的关系。

Un faux asthme lié à une compression bronchique par une artère pulmonaire gauche à trajet aberrant chez une enfant de 7 ans

Wheezing is common symptom in infants and is usually due to asthma. However an alternative diagnosis should be sought if there is no reversibility to B2-agonist. This case report describes a 7 years old child who had been treated for poorly controlled asthma for several years. The absence of B2-agonist reversibility, indirect signs of thoracic straining on spirometry and evidence of right heart decompensation raised doubts about the diagnosis. CT angiography demonstrated a pulmonary artery malformation. Formal pulmonary angiography confirmed the diagnosis of pulmonary artery sling. This malformation had been causing intermittent bronchial compression and the symptoms resolved after surgical intervention. Wheezing symptoms over two Years in a child, misdiagnosed as asthma, is an unusual presentation of this pulmonary vascular anomaly.

Vascular anomalies causing tracheoesophageal compression: Review of experience in children

Two hundred four infants and children (mean age 13 months) have undergone operation for the relief of tracheoesophageal obstruction resulting from vascular anomalies. One hundred thirteen patients had complete vascular rings (group I), 61 with double aortic arch and 52 with right aortic arch with a left ligamentum. Nine patients had a pulmonary artery sling (group II), 71 had innominate artery compression (group III), and 11 had miscellaneous anomalies (group IV). Patients were admitted with respiratory distress, stridor, apnea, dysphagia, or recurrent respiratory infections. Diagnosis was established by barium esophagogram in group I; barium esophagogram, bronchoscopy, and computed tomography or angiography in group II; bronchoscopy in group III; and barium esophagogram or angiography in group IV. The operative approach was through a left thoracotomy in group I, II and IV (93% of these patients) and through a right thoracotomy for group III (96% of these patients). The operative mortality rate was 4.9% and there were seven late deaths (3.4%). There have been no operative deaths in patients with isolated vascular anomalies in the past 28 years. Follow-up data from 1 month to 20 years (mean 8.5 months) were available on 159 patients; 141 (92%) were essentially free of symptoms, and 12 (8%) had residual respiratory problems. Five of six patients in group II having a lung scan postoperatively had a patent left pulmonary artery. A strong index of suspicion is necessary to avoid the complications of vascular rings in children. Barium swallow is the best single diagnostic technique for patients with complete vascular rings. A bronchoscopic study is required to diagnose innominate artery compression. Angiograms or computed tomographic scans are used to confirm the diagnosis of pulmonary artery sling. Left thoracotomy provides excellent exposure for all vascular rings except the displaced innominate artery, for which a right thoracotomy is the best approach.

Two-dimensional echocardiographic diagnosis of pulmonary artery sling in infancy

The vascular anomaly in which the left pulmonary artery arises from the right pulmonary artery and passes posteriorly and leftward between the trachea and the esophagus is termed a pulmonary artery sling. Two-dimensional echocardiograms were performed in five infants with this anomaly and successfully identified it in four, including one patient with truncus arteriosus communis. The subxiphoid long-axis sweep was useful in identifying the origin and initial course of the left pulmonary artery, and short-axis subxiphoid views showed both its origin from the right pulmonary artery and its initial posterior course. Angulation toward the cardiac apex displayed the right pulmonary artery in cross section anteriorly and the left pulmonary artery in cross section posteriorly. A transducer orientation midway between the subxiphoid long- and short-axis positions was helpful in distinguishing a large right upper lobe branch of the right pulmonary artery from a pulmonary artery sling. The precordial short-axis plane displayed the origin and initial posterior and leftward course of the left pulmonary artery, while the bifurcation of the main pulmonary artery, usually easily seen in this view, could not be demonstrated. Two-dimensional echocardiography offers a rapid, noninvasive diagnosis of pulmonary artery sling in infants.