Correction of left pulmonary artery with diffuse tracheal stenosis

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. 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: tracheal and bronchoconstriction Indication The sinus left pulmonary artery with diffuse tracheal stenosis correction is applicable to: 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. Make a transverse incision in the upper sternal fossa and a midline incision in the chest. Saw the sternum and remove part of the thymus to increase exposure. 2. Longitudinally cut the happy bag, free the total trunk of the pulmonary artery in the pericardial cavity. The left pulmonary artery was blocked by two vascular clamps at the origin of the left pulmonary artery. The left pulmonary artery was cut between the two clamps, and the distal end was moved to the trachea before the end of the pericardial cavity. End anastomosis. 3. After the left lung artery correction, free the innominate vein, gently pull the aortic arch forward and left to reveal the narrow trachea, separate the narrow trachea from the front, from the annular cartilage to the tracheal carina. 4. Systemic heparinization, ascending aorta and right atrium cannula, under the heartbeat, begin to bypass the cardiopulmonary bypass, in order to provide respiratory support when the trachea is cut open and tracheoplasty is performed. 5. Pull out the tracheal intubation, perform bronchoscopy, determine the extent of tracheal stenosis, cut out the appropriate size of the pericardium, and use the polypropylene line to make the pericardium and the anterior wall incision to enlarge the tracheal cavity and relieve the stenosis. . The suture should not penetrate the full layer of the tracheal wall. The advantage of autologous pericardial tablets is that it has strong anti-infective ability, can adapt to the growth and development of children, and does not have adverse reactions such as patch shrinkage. 6. After tracheoplasty, bronchoscopy should be performed again to see if the tracheal stenosis has been completely corrected. If it has been corrected, the bronchoscope is removed, the tracheal tube is inserted, and the surgical field is filled with saline to inflate the anesthesiologist with a pressure of 40 cm H2O. The lungs are observed for leaks in the suture. If there is no air leak, the operation is completed. complication 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. Damage to the trachea and bronchi Because the deformed blood vessels are densely attached to the trachea and bronchus, the trachea or bronchi can be damaged by inadvertent dissection, 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 embolism Occurred in the fascinating left pulmonary artery after vascular correction. 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.