Background: This study focused on the influence of concomitant anomalies and the individual surgical procedure.
Methods: Between 1984 and 2008, 32 patients underwent surgical repair of pulmonary artery sling (median, 7 month; range, 29 days to 9 years) in our institute. Twenty eight patients underwent left pulmonary artery reimplantation and tracheoplasty, whereas the other 4 had left pulmonary re-implantation only. For long segment tracheal stenosis, the early 4 patients were treated with a costal cartilage graft, and 19 patients with slide tracheoplasty. Five patients underwent tracheal resection with end-to-end anastomosis. Associated intracardiac anomalies were repaired concomitantly with left pulmonary artery reimplantation and tracheoplasty in 12 patients.
Results: There were 2 early deaths from low output syndrome and ventricular arrhythmia. Follow-up is complete in all patients (median, 5.1 years) with 3 late deaths from residual tracheal stenosis or pulmonary hypertension. Two survivors with a costal cartilage graft are free of respiratory problems. Of 16 survivors with slide tracheoplasty, 8 are fully active without tracheostomy and 8 with tracheostomy from tracheomalacia. Of 5 survivors with tracheal resection, 4 are doing well without tracheostomy. By echocardiography, the left pulmonary artery was patent in all assessed patients, but 2 patients had balloon arterioplasty.
Conclusion: Current strategy of left pulmonary re-implantation with simultaneous repair of tracheal stenosis and intracardiac anomalies results in a low operative mortality and satisfactory patency of left pulmonary artery. However, the management of younger infants with tracheoplasty for long segment stenosis involving carina or complex cardiac anomalies is still challenging.