Abstract
The term “ring-sling” complex describes a congenital anomaly in which the left pulmonary artery originates
anomalously from the right pulmonary artery plus complete tracheal rings. This article is the sequel of
the previously reported review of the literature which is devoted to the other facets of the over mentioned
complex. The present article elucidates the questions of the diagnostic and surgery of tracheal stenosis and
pulmonary sling. The review is based on the most actual publications some of them are fundamental and others
are modern. There are highlighted both the existing early and already resolved issues, as well as still unresolved
issues, which are encountered in a way of specialists dealing with this problem. Of course, such
patients today have the opportunity to receive the surgery, however, this is still possible only in a limited number
of clinics. A lot of these results of surgical repair in known clinics are presented. The optimal tactic
regarding the patients with pulmonary sling and tracheal stenosis is to be clarify but today it is evident that
the institutions with the multidisciplinary approach are the most successful. In turn, the timely detection of
indications for the surgical treatment is a rather complex issue, thus the discussion of that has also taken
place in the text of the publication. It should be noted that the review of literature is the second part of the
scientific work published earlier. Before this time an another issue is presented there have been already discussed
some questions that related to this scanty studied and, at the same time, very difficult topic. In fine,
since the last half century is passed, significant advances have been made in surgical treatment and care of
patients with «ring-sling» complex.
References
-
Berdon W.E., Baker D.H., Wung J.T., Chrispin A.,
Kozlowski K., de Silva M. et al. Complete cartilagering
tracheal stenosis associated with anomalous left
pulmonary artery: the ring-sling complex. Radiology.
1984; 152: 57–64. DOI: 10.1148/radiology.152.1.6729137
- Podzolkov V.P., Ivanitskiy A.V., Razumovskiy A.Yu.,Petrova N.N., Bondarev Yu.I., Mitina I.N. Sling of thepulmonary artery in a patient with an abnormality of theintrathoracic location of the heart (diagnosis and surgi-cal treatment). Grudnaya i Serdechno-Sosudistaya Khi-rurgiya (Russian Journal of Thoracic and CardiovascularSurgery). 1993; 4: 9–14 (in Russ.).
- Evans W.N., Acherman R.J., Ciccolo M.L., Carrillo
S.A., Mayman G.A., Luna C.F. et al. Vascular ring
diagnosis and management: Notable trends over
25 years. World J. Pediatr. Congenit. Heart Surg. 2016; 7
(6): 717–20. DOI: 10.1177/2150135116661279
- Gikonyo B.M., Jue K.L., Edwards J.E. Pulmonary
vascular sling: Report of seven cases and review of the
literature. Pediatr. Cardiol. 1989; 10: 81. DOI: 10.1007/BF02309919
- Bockeria L.A., Svobodov A.A., Nikiforov V.S., Ad-kin D.V., Yurpol'skaya L.Yu., Trunina I.I. et al. Case ofsuccessful correction of anomalous origin of left pul-monary artery with ASD in child at 6 months. DetskieBolezni Serdtsa i Sosudov (Children's Heart and VascularDiseases). 2010; 3: 68–9 (in Russ.)
- Kim A.I., Akatov D.S., Makarenko V.N., Mumlad-ze K.V., Nikiforov V.S. A case of successful correctionof anomalous origin of the left pulmonary artery withtracheal stenosis bougienage. Detskie Bolezni Serdtsa iSosudov (Children's Heart and Vascular Diseases). 2012;4: 54–7 (in Russ.).
- Razumovskiy A.Yu., Gorbachevskiy S.V., Shata-lov K.V., Kulikova N.V., Guz V.I., Stepanenko N.S.Sliding tracheoplasty cardiopulmonary bypass in chil-dren. First-hand experience in Russia. Annaly Khirurgii(Annals of Surgery). 2012; 1: 48–52 (in Russ.).
- Shatalov K.V., Razumovskiy A.Yu., Arnautova I.V.,Turdieva N.S. Surgical correction of the left pulmonaryartery sling in conjunction with tracheal stenosis ininfants. Detskie Bolezni Serdtsa i Sosudov (Children'sHeart and Vascular Diseases). 2015; 2: 34–8 (in Russ.).
- Bazylev V.V., Chernogrivov A.E., Chernogrivov I.E.Extremely rare congenital anomalies of the deviation ofone of the coronary arteries from the pulmonary arterysystem. Moscow; 2016 (in Russ.).
- Elliott M., Roebuck D., Noctor C., McLaren C.,
Hartley B., Mok Q. et al. The management of congenital
tracheal stenosis. Int. J. Pediatr. Otorhinolaryng.
2003; 67: S183–S192. DOI: 10.1016/j.ijporl.2003.08.023
- Alp H., Alpinar A., Pekcan S., Baysal T., Karaarslan S.
Pulmonary artery sling: Two different clinical entities.
J. Pediatr. Res. 2014; 1 (2): 87–8. DOI: 10.4274/jpr.43531
- Rogova T.V., Kim A.I., Kosheleva L.V., Biryukova M.V.Congenital infundibular stenosis of trachea: a hiddenthreat of death in patients with abnormal discharge ofthe left pulmonary artery. Detskie Bolezni Serdtsa iSosudov (Children's Heart and Vascular Diseases). 2015;1: 52–5 (in Russ.).
- Chernogrivov A.E., Chernogrivov I.E., Bazylev V.V.Anomalous origin of the left coronary artery from theright pulmonary artery. Grudnaya i Serdechno-Sosudis-taya Khirurgiya (Russian Journal of Thoracic and Car-diovascular Surgery).2016; 58 (5): 258–67 (in Russ.).
- Cohen S.R., Landing B.H. Tracheostenosis and bronchial
abnormalities associated with pulmonary artery
sling. Ann. Otol. Rhinol. Laryngol. 1976; 85 (5, Pt. 1):
582–90. DOI: 10.1177/000348947608500504
- Wells T.R., Gwinn J.L., Landing B.H., Stanley P.
Reconsideration of the anatomy of sling left pulmonary
artery: the association of one form with bridging
bronchus and imperforate anus. Anatomic and diagnostic
aspects. J. Pediatr. Surg. 1988; 23 (10): 892–8. DOI:10.1016/S00223468(88)80379-8
- Maliel K., Nasir J.M., Steel K. Pulmonary artery sling
initially presenting with symptoms during exercise. Am.
Osteopath. Coll. Radiol. 2013; 2 (Issue 2): 24–6.
- Quist-Hanssen S.V. Mutual compression of the right
main bronchus and an abnormal left pulmonary artery
as causes of the death of a 7 week old child. Acta
Paediatr. Scand. 1949; 37: 87–94. DOI: 10.1111/j.1651-2227.1949.tb15556.x
- Clarkson P.M., Ritter D.G., Rahimtoola S.H.,
Hallermann F.J., McGoon D.C. Aberrant left pulmonary
artery. Am. J. Dis. Child. 1967; 113 (3): 373–6.
DOI: 10.1001/archpedi.1967.02090180133015
- Dodge-Khatami A., Nijdam N.C., Broekhuis E., von Rosenstiel
E.A., Dahlem P.G., Hazekamp M.G. Carotid
artery patch plasty as a last resort repair for long-segment
congenital tracheal stenosis. J. Thorac. Cardiovasc.
Surg. 2002; 123: 826–8. DOI: 10.1067/mtc.2002.122065
- Bazylev V.V., Chernogrivov I.E., Gornostaev A.A.,Paramonova T.I., Chernogrivov A.E., Shiganov A.V.et al. An infant 3-month old case of ring-sling complexand salvage tracheoplasty after surgical correction ofdouble outlet right ventricle and re-implantation ofanomalous left pulmonary artery: management onbypass and extracorporeal membrane oxygenation.Detskie Bolezni Serdtsa i Sosudov (Children's Heart andVascular Diseases).2017; 4: 210–7 (in Russ.).
DOI: 10.24022/1810-0686-2017-14-4-210-217
- Nakajima J., Sunohara D., Kawashima H.A. Case of
pulmonary artery sling where onset was induced by
therapeutic hypothermia. Pediatr. Pulmonol. 2016;
9999: 1–4. DOI: 10.1002/ppul.23538
- Strenge S., Heinritz W., Zweier C., Rauch A., Rolle U.,
Merkenschlager A. et al. Pulmonary artery sling and
congenital tracheal stenosis in another patient with
Mowat–Wilson syndrome. Am. J. Med. Genet. Part.
2007; 143A: 1528–30. DOI: 10.1002/ajmg.a.31801
- Lee J.W., Printz B.F., Hegde S.R., Vargas L.A.,
Sun H.Y. Double trouble: fetal diagnosis of a pulmonary
artery sling and vascular ring. Clin. Case Rep. 2016; 4
(12): 1187–90. DOI: 10.1002/ccr3.733
- Oppido G., Napoleone C.P., Gargiulo G. Neonatal
right lung emphysema due to pulmonary artery sling.
Pediatr. Cardiol. 2008; 29 (2): 469–70. DOI: 10.1007/s00246-007-9084-0
- Kubota Y., Toyoda Y., Nagata N., Kubota H., Sawada
S., Murakawa M. Tracheo-bronchial angles in
infants and children. Anesthesiology. 1986; 64: 374–6.
DOI: 10.1097/00000542-198603000-00015
- Rosenberg B.F., Tantiwongse T., Wittenborg M.H.
Anomalous course of left pulmonary artery with respiratory
obstruction. Radiology. 1956; 67 (3): 339–45.
DOI: 10.1148/67.3.339
- Backer C.L., Russel H.M., Kaushal S., Rastatter J.C.,
Rigsby C.K., Holinger L.D. Pulmonary artery sling:
current results with cardiopulmonary bypass. J. Thorac.
Cardiovasc. Surg. 2012; 143: 144–51. DOI: 10.1016/j.jtcvs.2011.09.038
- Huang S., Wu E., Wang C., Chen S., Chen Y., Chang C.
et al. Surgical management of pulmonary artery sling:
Trachea diameter and outcomes with or without tracheoplasty.
Pediatr. Pulmonol. 2012; 47 (9): 903–8.DOI: 10.1002/ppul.22516
- Chiu P.P.L. Airway reconstruction team. Recent challenges
in the management of congenital tracheal stenosis:
an individualized approach. J. Pediatr. Surg. 2005;
40 (5): 774–80. DOI: 10.1016 /j.jpedsurg.2005.01.040
- Kagadis G.C., Panagiotopoulou E.C., Priftis K.N.,
Vaos G., Nikiforidis G.C., Anthracopoulos M.B. Preoperative
evaluation of the trachea in a child with pulmonary
artery sling using 3-dimensional computed
tomographic
imaging and virtual bronchoscopy. J. Pediatr.
Surg. 2007; 42 (5): E9–13. DOI: 10.1016/j.jpedsurg.2007.02.005
- Wijeweera O., Ng S.B. Retrospective review of tracheoplasty
for congenital tracheal stenosis. Singapore Med. J.
2011; 52 (10): 726–9.
- Hong X., Zhou G., Liu Y., Wang H., Feng Z.
Management of pulmonary sling with tracheal stenosis:
LPA re-implantation without tracheoplasty. J. Clin.
Exp. Med. 2015; 8 (2): 2741–7.
- Tsugawa C., Nishijima E., Muraji T., Satoh S.,
Takamizawa S., Yamaguchi M. et al. Tracheoplasty for
long segment congenital tracheal stenosis: Analysis of
29 patients over two decades. J. Pediatr. Surg. 2013; 38
(12): 1703–6. DOI: 10.1016/j.jpedsurg.2003.08.037
- Jonas R.A. Comprehensive surgical management of
congenital heart disease. 2th edn. Taylor and Francis
Group; 2014: 658.
- Turdieva N.S. Tactics of surgical treatment of vascularrings of isolated form and in combination with othercongenital heart defects in infants and young children.Dis. ... Cand. Med. Sci. Moscow; 2017 (in Russ.)
- Welsh T.M., Munro I.B. Congenital stridor caused by
an aberrant pulmonary artery. Arch. Dis. Child. 1954;
29 (144): 101–3. DOI: 10.1136/adc.29.144.101
- Potts W.J., Holinger P.H., Rosenblum A.H. Anomalous
left pulmonary artery сausing obstruction to right main
bronchus: report of a case. JAMA. 1954; 155: 1409–11.
- Contro S., Miller R.A.H., Potts W.I. Bronchial obstruction
due to pulmonary artery anomalies. I. Vascular
sling. Circulation. 1958; 17 (3): 418–23. DOI: 10.1161/01.CIR.17.3.418
- Cantrell J.R., Guild H.G. Congenital stenosis of the
trachea. Am. J. Surg. 1964; 108: 297–305. DOI:10.1016/0002-9610(64)90023-6
- Fonkalsrud E.W., Sumida S. Tracheal replacement with
autologous esophagous for tracheal stricture. Arch.
Surg. 1971; 102: 139–42. DOI: 10.1001/archsurg.1971.01350020049013
- Benjamin B., Pitkin J., Cohen D. Congenital tracheal
stenosis. Ann. Otol. 1981; 90: 364–71. DOI: 10.1177/000348948109000416
- Mansfield P.B. Tracheal resection in infancy. J. Pediatr.
Surg. 1980; 15: 79–81. DOI: 10.1016/S0022-3468(80)80408-8
- Grover F.L., Norton J.B. Jr, Webb G.E., Trinkle J.K.
Pulmonary sling. Case report and collective review.
J. Thorac. Cardiovasc. Surg. 1975; 69 (2): 295–300.
- Aytac, A., Özme S., Sarikayalar F., Saylam A. Pulmonary
artery sling. Ann. Thorac. Surg. 1976; 22 (6):
596–9. DOI: 10.1016/S0003-4975(10)64480-3
- Ein S.H., Freidberg J., Williams G.W., Rearon B.,
Barker J.A., Mancer K. Tracheoplasty – a new operation
for complete congenital tracheal stenosis. J.
Pediatr. Surg. 1982; 17 (6): 872–8. DOI: 10.1016/S0022-3468(82)80459-4
- Idriss F.S., DeLeon S.Y., Ilbawi M.N., Gerson C.R.,
Tucker G.F., Holinger L. Tracheoplasty with pericardial
patch for extensive tracheal stenosis in infants and children.
J. Thorac. Cardiovasc. Surg. 1984; 88: 527–36.
- Kimura K., Mukohara N., Tsugawa C., Matsumoto Y.,
Sugimura C., Murata H. Tracheoplasty for congenital
stenosis of the entire trachea. J. Pediatr. Surg. 1982; 17
(6): 869–71. DOI: 10.1016/S0022-3468(82)80458-2
- Hickey M.S.J., Wood A.E. Pulmonary artery sling
with tracheal stenosis: One-stage repair. Ann. Thorac.
Surg. 1987; 44: 416–7. DOI: 10.1016/S0003-4975(10)63807-6
- Wallace M.J., Charnsangavej C., Ogawa K., Carrasco
C.H., Wright K.C., McKenna R. Tracheobronchial
tree: expandable metallic stents used in experimental
and clinical applications. Work in progress. Radiology.
1986; 158 (2): 309–12. DOI: 10.1148/radiology.158.2.3941857
- Malmgren N., Laurin S., Lundström N.R. Pulmonary
artery sling. Diagnosis by magnetic resonance imaging.
Acta Radiol. 1988; 29 (1): 7–9. DOI: 10.1080/02841858809171202
- Tsang V., Murday A., Gillbe C., Goldstraw P. Slide tracheoplasty
for congenital funnel-shaped tracheal stenosis.
Ann. Thorac. Surg. 1989; 48: 632–5. DOI: 10.1016/0003-4975(89)90777-7
- Filler R.M., Forte V., Fraga J.C., Matute J. The use of
expandable metallic airway stents for tracheobronchial
obstruction in children. J. Pediatr. Surg. 1995; 30 (7):
1050–5; disc. 1055–6. DOI: 10.1016/0022-3468(95)90340-2
- Jacobs J.P., Elliott M.J., Haw M.P., Bailey C.M.,
Herberhold С. Pediatric tracheal homograft reconstruction:
A novel approach to complex tracheal
stenoses in children. J. Thorac. Cardiovasc. Surg. 1996;
112 (Issue 6): 1549–60. DOI: 10.1016/S0022-5223(96)70014-4
- Muraji T., Satoh S., Tsugawa C., Moriuchi T.,
Yamaguchi M., Matamoros M. et al. Slide tracheoplasty:
A case report of successful concomitant reconstruction
of extensive congenital tracheal stenosis and pulmonary
artery sling. J. Pediatr. Surg. 1998; 33: 1658–9.
DOI: 10.1016/S0022-3468(98)90603-0
- Othersen B.H., Hebra A., Tagge A.P.A. New method of
treatment for complete tracheal rings in an infant:
Endoscopic laser division and balloon dilation. J.
Pediatr. Surg. 2000; 35 (2): 262–4. DOI: 10.1016/S0022-3468(00)90021-6
- Van Son J.A.M., Hambsch J., Haas G.S., Schneider P.,
Mohr F.W. Pulmonary artery sling: reimplantation versus
antetracheal translocation. Ann. Thorac. Surg. 1999;
68 (3): 989–94. DOI: 10.1016/S0003-4975(99)00677-3
- Yorioka H., Kasamatsu A., Kanzaki H., Kawataki M.,
Yoo S.J. Prenatal diagnosis of fetal left pulmonary artery
sling. Ultrasound. Obstet. Gynecol. 2011; 37: 245–6.
DOI: 10.1002/uog.8804
- Lueck S., Mohr M., Werner C., Schmidt C., Malec E.,
Januszewska K. Temporary tracheal stenting after pulmonary
artery sling repair in a newborn. World J.
Pediatr. Congenit. Heart Surg. 2017; 2150135117713740.
DOI: 10.1177/2150135117713740
- Elliott M.J., Butler C.R., Varanou-Jenkins A.,
Partington L., Carvalho C., Samuel E. et al. Tracheal
replacement therapy with a stem cell-seeded graft:
Lessons from compassionate use application of a
GMP-compliant tissue-engineered medicine. Stem
Cells Transl. Med. 2017; 6 (6): 1458–64. DOI: 10.1002/sctm.16-0443
- Vondrys D., Elliott M.J., McLaren C.A., Noctor C.
Roebuck D.J. First experience with biodegradable airway
stents in children. Ann. Thorac. Surg. 2011; 92:
1870–4. DOI: 10.1016/j.athoracsur.2011.07.042
About the authors
- Chernogrivov Aleksey Evgen'evich, Dr. Med. Sc., Cardiovascular Surgeon, Highest Category, Chief of Department; orcid.org/0000-0002-6207-4799;
-
Chernogrivov Igor' Evgen'evich, Dr. Med. Sc., Cardiovascular Surgeon; orcid.org/0000-0002-6619-3875;
-
Bazylev Vladlen Vladlenovich, Dr. Med. Sc., Professor, Chief Physician; orcid.org/0000-0001-6089-9722
