European Journal of Pediatrics

, Volume 154, Issue 1, pp 2–14 | Cite as

Pulmonary sling: Morphological findings. Pre- and postoperative course

  • Christoph Döhlemann
  • Karl Mantel
  • Thomas J. Vogl
  • Thomas Nicolai
  • Karl Schneider
  • Ignaz Hammerer
  • Jürgen Apitz
  • Hans Meisner
  • Ingolf Joppich


Pulmonary sling (PS) is a congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery (RPA), forming a sling around the trachea causing tracheal compression. The incidence is not so rare as initially thought. Symptoms of severe airway obstruction often begin in the newborn or young infant. Echo-colour-Doppler may reveal the PS but emphysema can mask the typical findings. Deviation of fluid-filled lungs may be detected prenatally. Chest radiographs show unusual air distribution, deviation of heart and mediastinum and altered tracheobronchial angles. Bronchography and bronchoscopy demonstrate the high incidence of associated tracheal anomalies such as cartilagenous rings and long tracheal stenosis. Anterior oesophageal indentation is not always seen in the oesophogram. Magnetic resonance imaging (MRI) and computed tomography (CT) reveal the PS, but cautious interpretation is necessary because of different levels of the anomalous LPA. PS and associated cardiovascular malformations can be clearly detected by angiography. Associated extrathoracic anomalies are common. Early diagnosis and therapy of PS is mandatory and consists of reimplantation of the LPA into the pulmonary trunk and division of the ligamentum arteriosum. The postoperative course may be cumbersome necessitating bronchological interventions. Tracheal resection may be necessary but restenosis is frequent. A one-stage repair has been proposed in such cases and was successfully done in a few reported cases. Relief of respiratory obstruction is often complete when there are no associated tracheobronchial anomalies. Late postoperative course is favourable but respiratory obstructive attacks may occur with decreasing incidence over time and tracheal growth.

Key words

Pulmonary sling LPA variants Tracheobronchial angles Tracheal resection 



atrial septal defect type II

lig. art.

ligamentum arteriosum


left main bronchus


left pulmonary artery


left superior vena cava


main pulmonary artery


patient ductus arteriosus


pulmonary sling


right main bronchus


right pulmonary artery


ventricular septal defect


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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Christoph Döhlemann
    • 1
  • Karl Mantel
    • 1
  • Thomas J. Vogl
    • 2
  • Thomas Nicolai
    • 1
  • Karl Schneider
    • 1
  • Ignaz Hammerer
    • 3
  • Jürgen Apitz
    • 4
  • Hans Meisner
    • 5
  • Ingolf Joppich
    • 1
  1. 1.UniversitätskinderklinikMünchenGermany
  2. 2.Abteilung für RadiologieUniversität MünchenMünchenGermany
  3. 3.Universitätskinderklinik InnsbruckInnsbruckAustria
  4. 4.Abteilung für KardiologieUniversitätskinderklinikTübingenGermany
  5. 5.Klinik für Herz- GefässchirurgieDentsches HerzzentrumMünchenGermany

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