Combined Repair Of Pulmonary Artery Sling, Congenital Long Segment Tracheal Stenosis And Severe Rpa Stenosis
Raghav Murthy, MBBS, FACS1, Denis Levy, MD2, Matthew Brigger, MD1, John Nigro, MD1, John Lamberti, MD,FACS1.
1Rady Children's Hospital, University of California San Diego, San Diego, CA, USA, 2Kaiser S. California Med Group, San Diego, CA, USA.
OBJECTIVE: To demonstrate the technique, pearls and pitfalls to successfully performing a complete, single stage repair of pulmonary artery sling, severe right pulmonary artery stenosis and congenital tracheal rings.
METHODS: A 15 month old boy weighing 8.2 kgs, recently relocated to our city, presented with stridor. Cardiopulmonary work up revealed a pulmonary artery sling, severe RPA stenosis, hypoplasia of the right lung and long segment congenital tracheal stenosis (1st ring to trachea) and a patent ductus arteriosus. Surgical intervention included ligation and division of the patent ductus arteriosus. A Montgomery type suprahyoid release was performed. On cardiopulmonary bypass, the LPA was divided and transposed to bring it anterior to the trachea. An extensive slide tracheoplasty was performed from the first tracheal ring to the carina. The LPA was reimplanted into the main pulmonary artery. Extensive patch pulmonary arterioplasty was performed of the right artery from the hilum to the origin. The total cardiopulmonary bypass time was 355 mins. The pulmonary artery pressure was 1/3 systemic after the conclusion of the procedure.
RESULTS: The child had an excellent recovery. He was discharged home on POD 12.
CONCLUSIONS: Complex combined cardiac and tracheal surgery is feasible. This video demonstrates the technique, tricks, pearls and pitfalls to performing such an operation.
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