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P Venugopal - One of the best experts on this subject based on the ideXlab platform.
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Vascular rings and Pulmonary Artery Sling: early and mid-term results of surgical correction
Indian Journal of Thoracic and Cardiovascular Surgery, 2000Co-Authors: Uk Chowdhury, Balram Airan, Akhil Govil, Rajesh Sharma, Anil Bhan, Ss Kothari, A Saxena, P VenugopalAbstract:Background The great majority of patients with complete vascular rings and Pulmonary Artery Sling present before their first birthday. This retrospective report summarises the surgical experience of a single institution with the majority of vascular ring group presenting after infancy and having associated congenital cardiac anomalies. Possible reasons of delayed presentation of vascular ring, the asymptomatic left Pulmonary Artery Sling and the individualised surgical management of each subgroup are discussed. Methods Fifteen consecutive patients, aged 2 months to 9 years (mean±SD=41.33±31.55 months) underwent surgical correction of vascular rings and Sling during the last 12 years, including one infant. All patients underwent chest roentgenogram, barium esophagogram, two dimensional echocardiogram and cardiac catheterisation. Magnetic resonance imaging was employed in three patients. Four patients with isolated complete vascular ring were symptomatic (group A), one patient with left Pulmonary Artery Sling was asymptomatic (group B) and 10 symptomatic patients with complete vascular rings had associated congenital cardiac anomalies (group C). The operative approach was through a left posterolateral thoracotomy (n=5), a median sternotomy (n=8) and a combination of median sternotomy and left thoracotomy (n=2). Operations of various types were performed. Results The operative mortality was 6.6% and there was no late death. All survivors are doing well and asymptomatic after a mean follow up period of 66.87 months (range=1 month to 143 months). Postoperative barium esophagogram in all survivors revealed no stasis of contrast in the upper esophagus and marked diminution in the degree of esophageal indentations. Conclusions Accuracy in diagnosis is important to determine the optimal surgical approach. Individualization of surgical management provides gratifying results. Asymptomatic left Pulmonary Artery Sling without associated anomalies may be left untreated.
Mark W. Turrentine - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of Pulmonary Artery Sling and tracheal stenosis
The Annals of Thoracic Surgery, 2005Co-Authors: Andrew C Fiore, John W. Brown, Thomas R. Weber, Mark W. TurrentineAbstract:Background Pulmonary Artery Sling is a rare vascular ring and is commonly associated with tracheal stenosis. Symptomatic newborns and infants with these complex lesions have a high mortality rate without surgical intervention. The ideal operation remains controversial, with debate focusing on the need for left Pulmonary Artery for reimplantation and the technique of tracheal reconstruction. Methods From 1983 to 2003, 14 patients with Pulmonary Artery Sling (mean age, 7 months; range, 6 days to 27 months) underwent repair of Pulmonary Artery Sling alone (6 patients), tracheoplasty alone (1 patient), and Pulmonary Artery Sling repair with tracheoplasty (7 patients). Preoperatively, 7 patients were intubated, 2 had VATER (vertebral, anal, tracheal, esophageal, and radial anomalies) syndrome, and 2 patients had agenesis of the right lung. The left Pulmonary Artery was reimplanted at the ductal insertion site in 13 patients. One patient had left Pulmonary Artery translocation. Tracheoplasty employing extracorporeal circulation consisted of autologous pericardial patch (6 patients) or slide tracheoplasty (2 patients). Six patients with Pulmonary Artery Sling and mild tracheal stenosis required only left Pulmonary Artery reimplantation. Concomitant procedures included closure of atrial septal defect (4 patients), ventricular septal defect (4 patients), and shunt for Fallot's tetralogy (2 patients). Results There were 2 hospital deaths (2 of 14;14%) from abdominal sepsis (1) and renal failure (1). Reoperations included diaphragm plication (2), tracheostomy (1), and bronchoscopy with laser resection of granulation tissue (5 patients: 2 slide, 3 pericardium). Follow-up was complete in all patients (mean, 42 months) with 1 late death from fungal sepsis. At follow-up, all left Pulmonary Artery anastomoses were patent by echocardiography, and no patient has required reoperation for trachea reconstruction. Conclusions These data demonstrate that tracheal repair is not always necessary in the presence of Pulmonary Artery Sling; that agenesis of the right lung is not a contraindication to successful complete repair; and that simultaneous correction of intracardiac defects can be safely performed in selected patients. This study suggests that in newborns and infants, pericardial patch and slide tracheoplasty are effective methods for trachea reconstruction.
Carl L. Backer - One of the best experts on this subject based on the ideXlab platform.
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Vascular Rings, Tracheoplasty, and Pulmonary Artery Sling
Atlas of Pediatric Cardiac Surgery, 2015Co-Authors: Carl L. BackerAbstract:The phrase “vascular ring” refers to a group of vascular anomalies that result from abnormal development of the aortic arch system and cause compression of the trachea, the esophagus, or both. The vascular rings that form a true, complete ring and encircle both the esophagus and trachea are the double aortic arch and the right aortic arch with left ligamentum arteriosum. Partial vascular rings include innominate Artery compression syndrome, Pulmonary Artery Sling, and left aortic arch with aberrant right subclavian Artery. Patients with these anomalies also present with symptoms from esophageal and tracheal compression. Nearly two thirds of those with a Pulmonary Artery Sling have what is known as the “ring/Sling complex”—the combination of Pulmonary Artery Sling and complete tracheal rings—so the surgeon must be prepared to repair the trachea at the time of Pulmonary Artery Sling surgery.
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vascular rings and Pulmonary Artery Sling
2013Co-Authors: Carl L. Backer, Constantine MavroudisAbstract:Vascular rings are congenital vascular anomalies of the aortic arch system which compress the esophagus and trachea. The two major categories of vascular rings are double aortic arch and right aortic arch with left ligamentum. A diagnosis of a vascular ring requires a high index of suspicion by the clinician. Clues to this diagnosis are noisy breathing, a barky cough, recurrent upper respiratory tract infections, and dysphagia. Vascular rings are repaired through a thoracotomy with division of the ligamentum, division of the smaller of the two aortic arches for double aortic arch, and resection of a Kommerell diverticulum if present. Almost all patients have resolution of their symptoms over a period of 6 months to 1 year. Patients with a Pulmonary Artery Sling frequently have associated tracheal stenosis from complete cartilaginous tracheal rings. Repair is performed through a median sternotomy with the use of cardioPulmonary bypass. Simultaneous repair of associated intracardiac lesions and slide tracheoplasty for congenital tracheal stenosis are performed. Care of these patients requires multidisciplinary cooperation between cardiothoracic surgery, otolaryngology, anesthesia, and critical care.
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Pulmonary Artery Sling: Current results with cardioPulmonary bypass
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Carl L. Backer, Hyde M. Russell, Sunjay Kaushal, Jeffrey C. Rastatter, Cynthia K. Rigsby, Lauren D. HolingerAbstract:Objective We have used cardioPulmonary bypass with left Pulmonary Artery reimplantation for Pulmonary Artery Sling repair since 1985. This review presents our current results with this technique, emphasizing the importance of diagnosis and treatment of frequently associated tracheal stenosis. Methods Since 1985, 34 patients have undergone Pulmonary Artery Sling repair using a median sternotomy and cardioPulmonary bypass. Age ranged from 9 days to 43 years (mean 2.1 ± 7.5 years, median 0.2 years). Twenty-seven patients (79%) had tracheal stenosis secondary to complete cartilage tracheal rings. All patients had preoperative airway imaging with rigid bronchoscopy, and since 2000 all patients have had computed tomography imaging of the chest with 3-dimensional reconstruction (n = 14). Tracheal repair has included pericardial patch tracheoplasty (n = 7), tracheal autograft (n = 10), tracheal resection (n = 4), and slide tracheoplasty (n = 5). All patients had an echocardiogram, and cardiac lesions repaired simultaneously included atrial septal defect (4), tetralogy of Fallot (2), and ventricular septal defect (1). One patient had a severely hypoplastic right lung, and 3 patients had an absent right lung. In these patients, the left Pulmonary Artery was translocated anterior to the trachea. In all other patients, the left Pulmonary Artery was reimplanted into the main Pulmonary Artery. Results There have been no early deaths or complications related to the use of cardioPulmonary bypass. Median hospital stay was 24 days. There have been 4 late deaths. Two late deaths were the result of complications of tracheal surgery (1 pericardial patch [6 months postoperatively] and 1 autograft [1.7 years postoperatively]). One child died of biliary atresia (0.2 years postoperatively), and 1 child died of pneumonia (5.8 years postoperatively). All recent tracheal stenosis repairs have been with slide tracheoplasty. All left Pulmonary arteries are patent with a mean percent flow by perfusion scan of 41% ± 13%. Older patients (n = 2) have noted a significant improvement in exercise tolerance. Conclusions Pulmonary Artery Sling is best repaired with median sternotomy, cardioPulmonary bypass, and left Pulmonary Artery reimplantation. This resulted in uniformly patent left Pulmonary arteries in all patients. Preoperative computed tomography imaging, echocardiography, and bronchoscopy are essential for precise operative planning. The frequently associated tracheal stenosis is best repaired with slide tracheoplasty.
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Diagnostic Issues and Indications for Surgery in Patients With Pulmonary Artery Sling
Circulation, 1998Co-Authors: Carl L. BackerAbstract:To the Editor: This letter is in reference to the brief article entitled “Combined Pulmonary Artery Angiography and Tracheobronchography in Pulmonary Artery Sling,” authored by Joachim Freihorst and Thomas Paul ( Circulation . 1997;96:2079). The authors reported their evaluation of a 12-month-old child with inspiratory and expiratory stridor. Barium swallow showed an anterior impression of the esophagus (consistent with a Pulmonary Artery Sling). Two-dimensional echocardiogram could not visualize the origin of the left Pulmonary Artery. The authors proceeded to do combined Pulmonary angiography and tracheobronchography to diagnose the Pulmonary Artery Sling. The figure showing the combined contrast injection in the Pulmonary Artery and lower trachea is a nice demonstration of Pulmonary Artery Sling, but in my experience, these are 2 unnecessary studies. In our recent experience, the diagnosis of Pulmonary Artery Sling has been possible in all cases with a comprehensive echocardiographic analysis.1 We reviewed 19 cases of Pulmonary …
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Pulmonary Artery Sling. Results of surgical repair in infancy.
The Journal of Thoracic and Cardiovascular Surgery, 1992Co-Authors: Carl L. Backer, Farouk S. Idriss, Lauren D. Holinger, Constantine MavroudisAbstract:Pulmonary Artery Sling is a rare congenital vascular anomaly in which the left Pulmonary Artery originates from the right Pulmonary Artery and encircles the right main-stem bronchus and distal trachea before entering the hilum of the left lung. This causes compression of the trachea and right main-stem bronchus, and most infants with this anomaly have severe respiratory distress within the first year of life. Between 1953 and 1990 12 infants (nine male, three female) underwent surgical repair of Pulmonary Artery Sling. Ages ranged from 8 days to 9 months (mean age 5 months). Bronchoscopic examination was performed in all patients. Complete tracheal rings were the most common associated lesion (five patients). Nine patients had Pulmonary angiography. Most recently, computed tomography and magnetic resonance imaging have been used to diagnose Pulmonary Artery Sling and associated complete tracheal rings when present. Surgical repair consisted of transection of the left Pulmonary Artery at its origin and implantation into the main Pulmonary Artery anterior to the trachea via right thoracotomy (one), left thoracotomy (six), or median sternotomy (five). Three patients had simultaneous pericardial patch tracheoplasty for complete tracheal rings. There were no operative deaths. Two late deaths occurred, at 7 months and 2.5 years postoperatively. Of 10 long-term survivors nine have had postoperative studies to determine the patency of the left Pulmonary Artery. Seven anastomoses were patent (78%). Pulmonary Artery Sling can be repaired in infancy with low operative mortality and excellent long-term patency of the left Pulmonary Artery by dividing the left Pulmonary Artery and implanting it into the main Pulmonary Artery anterior to the trachea. Simultaneous pericardial patch tracheoplasty should be performed if complete tracheal rings are associated. We recommend repair at the time of diagnosis with median sternotomy and extracorporeal circulation.
Uk Chowdhury - One of the best experts on this subject based on the ideXlab platform.
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Vascular rings and Pulmonary Artery Sling: early and mid-term results of surgical correction
Indian Journal of Thoracic and Cardiovascular Surgery, 2000Co-Authors: Uk Chowdhury, Balram Airan, Akhil Govil, Rajesh Sharma, Anil Bhan, Ss Kothari, A Saxena, P VenugopalAbstract:Background The great majority of patients with complete vascular rings and Pulmonary Artery Sling present before their first birthday. This retrospective report summarises the surgical experience of a single institution with the majority of vascular ring group presenting after infancy and having associated congenital cardiac anomalies. Possible reasons of delayed presentation of vascular ring, the asymptomatic left Pulmonary Artery Sling and the individualised surgical management of each subgroup are discussed. Methods Fifteen consecutive patients, aged 2 months to 9 years (mean±SD=41.33±31.55 months) underwent surgical correction of vascular rings and Sling during the last 12 years, including one infant. All patients underwent chest roentgenogram, barium esophagogram, two dimensional echocardiogram and cardiac catheterisation. Magnetic resonance imaging was employed in three patients. Four patients with isolated complete vascular ring were symptomatic (group A), one patient with left Pulmonary Artery Sling was asymptomatic (group B) and 10 symptomatic patients with complete vascular rings had associated congenital cardiac anomalies (group C). The operative approach was through a left posterolateral thoracotomy (n=5), a median sternotomy (n=8) and a combination of median sternotomy and left thoracotomy (n=2). Operations of various types were performed. Results The operative mortality was 6.6% and there was no late death. All survivors are doing well and asymptomatic after a mean follow up period of 66.87 months (range=1 month to 143 months). Postoperative barium esophagogram in all survivors revealed no stasis of contrast in the upper esophagus and marked diminution in the degree of esophageal indentations. Conclusions Accuracy in diagnosis is important to determine the optimal surgical approach. Individualization of surgical management provides gratifying results. Asymptomatic left Pulmonary Artery Sling without associated anomalies may be left untreated.
Andrew C Fiore - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment of Pulmonary Artery Sling and tracheal stenosis
The Annals of Thoracic Surgery, 2005Co-Authors: Andrew C Fiore, John W. Brown, Thomas R. Weber, Mark W. TurrentineAbstract:Background Pulmonary Artery Sling is a rare vascular ring and is commonly associated with tracheal stenosis. Symptomatic newborns and infants with these complex lesions have a high mortality rate without surgical intervention. The ideal operation remains controversial, with debate focusing on the need for left Pulmonary Artery for reimplantation and the technique of tracheal reconstruction. Methods From 1983 to 2003, 14 patients with Pulmonary Artery Sling (mean age, 7 months; range, 6 days to 27 months) underwent repair of Pulmonary Artery Sling alone (6 patients), tracheoplasty alone (1 patient), and Pulmonary Artery Sling repair with tracheoplasty (7 patients). Preoperatively, 7 patients were intubated, 2 had VATER (vertebral, anal, tracheal, esophageal, and radial anomalies) syndrome, and 2 patients had agenesis of the right lung. The left Pulmonary Artery was reimplanted at the ductal insertion site in 13 patients. One patient had left Pulmonary Artery translocation. Tracheoplasty employing extracorporeal circulation consisted of autologous pericardial patch (6 patients) or slide tracheoplasty (2 patients). Six patients with Pulmonary Artery Sling and mild tracheal stenosis required only left Pulmonary Artery reimplantation. Concomitant procedures included closure of atrial septal defect (4 patients), ventricular septal defect (4 patients), and shunt for Fallot's tetralogy (2 patients). Results There were 2 hospital deaths (2 of 14;14%) from abdominal sepsis (1) and renal failure (1). Reoperations included diaphragm plication (2), tracheostomy (1), and bronchoscopy with laser resection of granulation tissue (5 patients: 2 slide, 3 pericardium). Follow-up was complete in all patients (mean, 42 months) with 1 late death from fungal sepsis. At follow-up, all left Pulmonary Artery anastomoses were patent by echocardiography, and no patient has required reoperation for trachea reconstruction. Conclusions These data demonstrate that tracheal repair is not always necessary in the presence of Pulmonary Artery Sling; that agenesis of the right lung is not a contraindication to successful complete repair; and that simultaneous correction of intracardiac defects can be safely performed in selected patients. This study suggests that in newborns and infants, pericardial patch and slide tracheoplasty are effective methods for trachea reconstruction.
