Analysis Of The Prognosis Of Patients With Pulmonary Artery Sling Combined With Tracheal Stenosis Without Tracheal Intervention

Background:Pulmonary Artery Sling(PAS)is a rare congenital cardiovascular malformation.Abnormally left pulmonary compression causes stenosis of the trachea.Tracheal intervention refers to the treatment of tracheal stenosis,including tracheoplasty or tracheal stent implantation.At present,there is still a lot of controversy about whether PAS patients with tracheal stenosis undergoing tracheal intervention at the same time of left pulmonary artery transplantation.In the early days,some scholars suggested that both the left pulmonary artery and the trachea should be cured at the same time,because complete trachea ring affects the prognosis of PAS patients seriously.But the operation of trachea is difficult,with many complications and high mortality.Some scholars began to try to treat PAS patients without tracheal intervention,because the pressure of the trachea is relieved after left pulmonary artery transplantation,the respiratory symptoms of PAS patients are obviously improved.There is no prediction index of avoiding tracheal intervention in preoperative at present.Objective:To analyze the prognosis of PAS/TS without tracheal intervention,to find the predictor of avoiding tracheal intervention in preoperative,and to explore the method of improving the treatment effect of this disease.Methods:Descriptive epidemiological methods were used.A total of 17 PAS/TS patients receiving left pulmonary artery re-implantation without tracheal intervention were recruited.The clinical outcome and prognosis were evaluated,and effectiveness of various managements was analyzed.Results:Of the 17 patients received re-implantation of the left pulmonary artery without tracheal intervention,extubation was successfully performed in 12 patients and they recovered uneventfully.The remaining 5 patients received tracheal intervention after the first operation,3 patients received tracheal stent implantation and died from infection and multiple organ failure,two received traheoplasty and died from infection and tracheal leak.Respiratory symptoms were reduced or disappear in all survivors.Diameter/length(%)in survivors without tracheal intervention was significantly higher than those who received tracheal intervention.Patients with PA sling undergoing LPA re-implantation achieved a good outcome if the diameter/length(%)of the trachea was up(10.14±1.58)%.Patients with PA sling undergoing LPA re-implantation achieved a bad outcome if the diameter/length(%)of the trachea was blow(5.72±1.1%).Conclusion:Patients with PAS/TS undergoing LPA re-implantation without tracheal intervention could achieve a good outcome.Diameter/length(%)may be a more reliable indicator used for determination of tracheal intervention in surgical management of PA sling.Whether the dead patients may have a better result or not if they received LPA re-implantation and tracheal intervention simultaneously was unknown.