Thorac Cardiovasc Surg 2020; 68(01): 051-058
DOI: 10.1055/s-0039-1678670
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Combined Surgical and Endoscopic Approach for Ring–Sling Complex

Giulio Porcedda
1  Department of Pediatric Cardiology, Anna Meyer Children Hospital, Florence, Italy
,
Alice Brambilla
1  Department of Pediatric Cardiology, Anna Meyer Children Hospital, Florence, Italy
,
Silvia Favilli
1  Department of Pediatric Cardiology, Anna Meyer Children Hospital, Florence, Italy
,
Bruno Murzi
2  Department of Pediatric Cardiac Surgery, Heart Hospital, G. Monasterio Foundation, Massa, Italy
,
Lorenzo Mirabile
3  Intensive Care Unit, Anna Meyer Children Hospital, Florence, Italy
,
Roberto Baggi
3  Intensive Care Unit, Anna Meyer Children Hospital, Florence, Italy
,
Luigi Arcieri
2  Department of Pediatric Cardiac Surgery, Heart Hospital, G. Monasterio Foundation, Massa, Italy
› Author Affiliations
Further Information

Publication History

14 October 2018

07 January 2019

Publication Date:
11 February 2019 (online)

Abstract

Background Left pulmonary artery (LPA) sling (PAS) is a vascular ring, which is frequently associated with long-segment tracheal stenosis (TS). Mortality rate in operated children is still high, especially in cases of severe tracheal hypoplasia and/or associated congenital heart defects (CHDs). We report our experience of treatment and follow-up in a pediatric cohort of patients affected by PAS with severe tracheobronchial involvement.

Methods From 2005 to 2017, we enrolled 11 children diagnosed with PAS and congenital TS requiring surgical intervention. Echocardiography, computed tomography, and bronchoscopy were performed in all patients. Associated CHD were present in 5 (45%) patients. Tracheal reconstruction techniques included slide tracheoplasty (7/11; 63%), slide tracheoplasty and costal cartilage graft (2/11; 18%), and Hazekamp technique (2/11; 18%).

Nine patients underwent LPA direct reimplantation and concomitant tracheoplasty; concomitant surgical repair for CHD was performed in three children.

Results Over a mean follow-up of 30 months (range: 3–75 months), a late mortality of 18% was registered; no early death occurred. Good flow through LPA could be documented in all patients. Ten children required operative bronchoscopies (mean: 16/patients) aimed at stent positioning/removal, treatment of granulomas, and tracheobronchial dilatation.

Conclusions Severe tracheobronchial stenosis and associated CHD were the main determinants for hospitalization time, intensive assistance, and repeated endoscopic procedures.

Patients affected by PAS/TS complex require a careful management at high-specialized centers providing multidisciplinary team.

Respiratory endoscopy may play a central role both in preoperatory assessment and in postoperative management of patients showing severe tracheobronchial involvement.