Pulmonary sling correction

The left pulmonary artery is also called the pulmonary artery sling. The left pulmonary artery abnormality originates from the right pulmonary artery, and the path is between the trachea and the esophagus (Fig. 6.11.4.1-0-1). It can compress the trachea and right bronchus and affect the development of the tracheal cartilage ring. Often combined with tracheal ring lesions. Compression of the right bronchus can form a flap, which makes it difficult to exhale, which can cause excessive inflation of the right lung. In severe cases of tracheal compression, both lungs can be over-inflated, but usually the right side is heavier than the left side. Can be combined with left superior vena cava, atrial, ventricular septal defect, patent ductus arteriosus, congenital megacolon and biliary atresia. Most of the sick children have symptoms such as wheezing, difficulty breathing, cyanosis, asphyxia, etc., and a few may have no obvious symptoms or have symptoms late. Chest X-ray showed that the right lung was over-inflated, the left hilar position was low, and the trachea was biased to the healthy side. The lateral radiograph of the esophagus showed the erosion of the esophageal leading edge. Pulmonary angiography is feasible if necessary to confirm the diagnosis. Patients with symptoms should be treated immediately. If not treated in time, most of the sick children will die within 6 months. Potts was the first to use the right chest diameter to correct the left pulmonary artery in 1954. However, the right side of the thoracic obstruction of the left pulmonary artery for vascular anastomosis, easy to affect right side ventilation, can cause hypoxia, and the incidence of intraoperative ventricular rhythm disorder is high. The left chest path can well expose the lesion and facilitate vascular anastomosis. However, if the trachea or bronchial abnormalities are combined, the incision is difficult to treat at the same time. Treatment of diseases: esophageal compression cervical spondylosis Indication If the trachea and/or esophagus have obvious symptoms of compression, surgical treatment should be performed immediately after diagnosis to avoid suffocation. Preoperative preparation 1. People with respiratory infections should apply antibiotics before surgery and remove respiratory secretions to control infection. 2. Infants and young children with malnutrition must be given supportive treatment such as transfusion and rehydration before surgery to improve the general condition. Surgical procedure 1. Selection of surgical approach: The surgical approach of pulmonary sling correction has a right chest or left chest posterior incision and a chest midline incision. The latter can not only reveal the lesion well, but also under the cardiopulmonary bypass. Good tracheal resection and anastomosis, or tracheoplasty can also get good respiratory support. However, in view of the wide application of the left chest path, the path is taken as an example. 2. The third or fourth intercostal space of the left chest is inserted into the chest. 3. Cut the mediastinal pleura, free the left vagus nerve, expose the arterial ligament, and cut it after suturing. 4. Dissociate the left pulmonary artery behind the trachea and carefully separate the adhesion between the left pulmonary artery and the trachea. Two longitudinal pericardial incisions were made in front of and behind the left phrenic nerve. The happy pericardium was cut and the total trunk of the pulmonary artery was freed in the pericardial cavity. 5. Use a special two infant-type non-invasive vascular clamp to block the blood vessel at the origin of the left pulmonary artery, and observe the heart rate, blood pressure and ECG changes of the sick child to determine whether the sick child can tolerate. 6. If the sick child can tolerate, cut the blood vessel between the two vascular clamps, that is, at the origin of the left pulmonary artery, and move the distal end of the severed left pulmonary artery to the front of the trachea. The pericardial incision behind the left phrenic nerve enters the pericardial cavity to avoid an angle, and then an end-to-end anastomosis with the proximal end. The left pulmonary artery can also be clamped at the origin, and the proximal end is sutured, and the distal end is moved to the front of the trachea. The same path is used to enter the pericardial cavity and the pulmonary artery trunk to make an end-to-side anastomosis. 7. Fully free the airway and adhesion tissue around the right bronchi. complication 1. Tracheal softening: Due to long-term compression of the trachea, once the vascular malformation is corrected, some patients may have airway obstruction leading to airway obstruction and asphyxia. It should be processed immediately. 2. Injury of the trachea and bronchus: due to the dense adhesion of the deformed blood vessels to the trachea and bronchus, inadvertently, the trachea or bronchi can be damaged when peeling off, resulting in tracheal or bronchopleural palsy. Once it occurs, it should be immediately closed drainage, systemic application of antibiotics to control infection. Long-term non-healing should be treated surgically. 3. Left pulmonary artery embolism: occurs after vascular surgery in the left pulmonary artery of the fascinated. The reasons are related to left pulmonary artery dysplasia, angular deformity after angioplasty, anastomotic embolism, scar stenosis and other factors. Should pay attention to prevention. Once the left pulmonary artery embolism occurs, it is not appropriate to re-operation. The reasons are as follows: 1 patients often have left pulmonary artery dysplasia, it is difficult to maintain blood circulation after reoperation. 2 The risk of pulmonary hypertension after embolization of the left pulmonary artery is small. 3 Most patients with left pulmonary embolism have no clinical symptoms.