Skip to main content
SpringerLink
Log in

Pulmonary vascular sling: Report of seven cases and review of the literature

  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Summary

A total of 130 cases of pulmonary vascular sling, including seven new cases in our collection, were studied. The sex distribution was 60% male and 40% female. The age at presentation was in the first year of life in ∼90% of cases. Barium-esophagraphy showing anterior indentation was diagnostic in most of the cases. Bronchoscopy and tracheobronchography were useful in detecting associated tracheobronchial anomalies preoperatively. The analysis of 68 autopsied cases revealed associated tracheobronchial anomalies in 40% of the cases. Anomalies of the tracheobronchial tree took three major forms: abnormal distribution of cartilage in the walls of the trachea and major bronchi, intrinsic stenosis, and abnormal branching, the latter being that ofbronchus suis. Acquired changes secondary in the sling resulted in compression of the major respiratory pathway by the anomalous left pulmonary artery. Major associated cardiovascular anomalies were present in 30% of the cases. These were represented by ventricular septal defect, atrial septal defect, patent ductus arteriosus, tetralogy of Fallot, common ventricle, and coarctation of the aorta.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anderson MG, Levin SE, Milner S (1975) Aberrant left pulmonary artery. A rare cause of congenital stridor.S Afr Med J 49:225–228

    CAS  PubMed  Google Scholar 

  2. Aytac A, Ozme S, Sarikayalar F, Saylam A (1976) Pulmonary artery sling.Ann Thorac Surg 22:596–599

    CAS  PubMed  Google Scholar 

  3. Bamman JL, Ward BH, Woodrum DE (1977) Aberrant left pulmonary artery: clinical and embryologic factors.Chest 72:67–71

    CAS  PubMed  Google Scholar 

  4. Berdon WE, Baker DH, Wung J-T, Chrispin A, Kozlowski K, de Silva M, Bales P, Alford B (1984) Complete cartilage-ring tracheal stenosis associated with anomalous left pulmonary artery: the ring-sling complex.Radiology 152:57–64

    CAS  PubMed  Google Scholar 

  5. Campbell CD, Wernly JA, Koltip PC, Vitullo D, Replogle RL (1980) Aberrant left pulmonary artery (pulmonary artery sling): successful repair and 24 year follow-up report.Am J Cardiol 45:316–320

    CAS  PubMed  Google Scholar 

  6. Capitanio MA, Ramos R, Kirkpatrick JA (1971) Pulmonary sling: roentgen observations.Am J Roentgenol 112:28–34

    CAS  Google Scholar 

  7. Castaneda-Zuniga WR, Amplatz K, Edwards JE (1978) Anterior vascular indentation of the oesophagus.Br J Radiol 51:633–635

    CAS  PubMed  Google Scholar 

  8. Chih-Hsiang H (1964) Anomalous left pulmonary artery causing stenosis of trachea.Chin Med J 83:475–477

    Google Scholar 

  9. Clarkson PM, Ritter DG, Rahimtoola SH, Hallermann FJ, McGoon DC (1967) Aberrant left pulmonary artery.Am J Dis Child 113:373–377

    CAS  PubMed  Google Scholar 

  10. Cohen SR, Landing BH (1976) Tracheostenosis and bronchial abnormalities associated with pulmonary artery sling.Ann Otol Rhinol Laryngol 85:582–590

    CAS  PubMed  Google Scholar 

  11. Contro S, Miller RA, White H, Potts WJ (1958) Bronchial obstruction due to pulmonary artery anomalies. I. Vascular sling.Circulation 17:418–423

    CAS  PubMed  Google Scholar 

  12. Derrick JR, Stoeckle H (1960) Bronchial obstruction secondary to an aberrant pulmonary artery.Am J Dis Child 99:830–832

    CAS  PubMed  Google Scholar 

  13. Dumler MP (1966) A rare cause of dysphagia: anomalous left pulmonary artery.JAMA 197:513–514

    Article  CAS  PubMed  Google Scholar 

  14. Dunn JM, Gordon I, Chrispin AR, de Leval MR, Stark J (1979) Early and late results of surgical correction of pulmonary artery sling.Ann Thorac Surg 28:230–238

    CAS  PubMed  Google Scholar 

  15. Eklof O, Ekstrom G, Eriksson BO, Michaelsson M, Stephensen O, Soderlund S, Thoren C, Wallgren G (1971) Arterial anomalies causing compression of the trachea and/or the oesophagus: a report of 30 symptomatic cases.Acta Paediatr Scand 60:81–89

    CAS  PubMed  Google Scholar 

  16. Fontan A, Verger P, Bricaud H, Battin JJ (1964) Anomalie de division de l'artere pulmonaire avec trajet recurrent de la branche gauche et obstruction respiratoire chronique.Ann Pediatr (Paris) 11:333–340

    CAS  Google Scholar 

  17. Gallo P, Fazzari F, La Magra C, Lecchini PM, Nardi F (1981) Facio-auriculo-vertebral anomalad and pulmonary artery sling: a hitherto undescribed but probably non-casual association.Pathol Res Pract 173:172–179

    CAS  PubMed  Google Scholar 

  18. Glacvecke H, Doehle W (1897) Ueber eine seltene angeborene Anomalie der Pulmonalarterie.Munch Med Wochenschr 44:950–953

    Google Scholar 

  19. Grover FL, Norton JB Jr, Webb GE, Trinkle JK (1975) Pulmonary sling: case report and collective review.J Thorac Cardiovasc Surg 69:295–300

    CAS  PubMed  Google Scholar 

  20. Gumbiner CH, Mullins CE, McNamara DG (1980) Pulmonary artery sling.Am J Cardiol 45:311–315

    Article  CAS  PubMed  Google Scholar 

  21. Han BK, Dunbar JS, Bove K, Rosenkrantz JG (1980) Pulmonary vascular sling with tracheobronchial stenosis and hypoplasia of the right pulmonary artery.Pediatr Radiol 9:113–115

    Article  CAS  PubMed  Google Scholar 

  22. Hatten HP Jr, Lorman JG, Rosenbaum HD (1977) Pulmonary sling in the adult.Am J Roentgenol 128:919–921

    Google Scholar 

  23. Heinemann F (1964) Stenose der Trachea durch anormalen Verlauf der Arteria pulmonalis sinistra.Med Welt 33:1592–1593

    Google Scholar 

  24. Hewitt RL, Brewer PL, Drapanas T (1970) Aortic arch anomalies.J Thorac Cardiovasc Surg 60:746–753

    CAS  PubMed  Google Scholar 

  25. Hiller HG, Maclean AD (1957) Pulmonary artery ring.Acta Radiol 48:434–438

    CAS  PubMed  Google Scholar 

  26. Idriss FS, DeLeon SY, Ilbawi MN, Gerson CR, Tucker GF, Holinger L (1984) Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children.J Thorac Cardiovasc Surg 88:527–536

    CAS  PubMed  Google Scholar 

  27. Jacobson JH II, Morgan BC, Andersen DH, Humphreys GH II (1960) Aberrant left pulmonary artery: a correctable cause of respiratory obstruction.J Thorac Cardiovasc Surg 39:602–612

    PubMed  Google Scholar 

  28. Jue KL, Edwards JE (1985) Anomalous left pulmonary artery sling revisited with a proposed classification [abstr]. In: Doyle EF, Engle MA, Gersony WM, Rashkind WJ, Talner NS (eds)Second world congress of pediatric cardiology 1985. Springer-Verlag, New York, p 74

    Google Scholar 

  29. Jue KL, Raghib G, Amplatz K, Adams P Jr, Edwards JE (1965) Anomalous origin of the left pulmonary artery from the right pulmonary artery: report of 2 cases and review of the literature.Am J Roentgenol 95:598–610

    CAS  Google Scholar 

  30. Kale MK, Rafferty RE, Carter RW (1970) Aberrant left pulmonary artery presenting as a mediastinal mass: report of a case in an adult.Arch Intern Med 125:121–125

    Article  CAS  PubMed  Google Scholar 

  31. Koopot R, Nikaidoh H, Idriss FS (1975) Surgical management of anomalous left pulmonary artery causing tracheobronchial obstruction.J Thorac Cardiovasc Surg 69:239–246

    CAS  PubMed  Google Scholar 

  32. Langlois J, Binet JP, Planche C, Conso JF, Razafinombana A (1971) L'artere pulmonaire gauche aberrante: a propos de 5 cas operes.Arch Mal Coeur 71:573–584

    Google Scholar 

  33. Langlois J, Binet J-P, Planche C, Conso J-F, Razafinombana A (1978) L'artere pulmonaire gauche aberrante: a propos de cinq cas operes.Chirurgie 104:58–73

    CAS  PubMed  Google Scholar 

  34. Lenox CC, Crisler C, Zuberbuhler JR, Park SC, Neches WH, Mathews RA, Fricker FJ, Golding LA (1979) Anomalous left pulmonary artery: successful management.J. Thorac Cardiovasc Surg 77:748–752

    CAS  PubMed  Google Scholar 

  35. Lincoln JCR, Deverall PB, Stark J, Aberdeen E, Waterston DJ (1969) Vascular anomalies compressing the oesophagus and trachea.Thorax 24:295–306

    CAS  PubMed  Google Scholar 

  36. Lubbers WJ, Tegelaers WHH, Losekoot TG, Becker AE (1975) Aberrant origin of left pulmonary artery (vascular sling): report of the clinical and anatomic features in three patients.Eur J Cardiol 2:477–483

    CAS  PubMed  Google Scholar 

  37. Mayer JE Jr, Joyce LD, Reinke D, McGeachie R, Humphrey EW, Varco RL (1976) Aberrant left pulmonary artery presenting as a right paratracheal mass in an adult.J Thorac Cardiovasc Surg 72:571–574

    PubMed  Google Scholar 

  38. McCormack RJM (1969) Pulmonary artery sling [abstr].Thorax 24:509

    CAS  PubMed  Google Scholar 

  39. Molz G (1969) Abnorm verlaufende linke Pulmonalarterie mit Umschlingung des rechten Stammbronchus und der Trachea als Grundlage einer Ventilationsbehinderung.Thorax-chirurgie 17:203–213

    CAS  Google Scholar 

  40. Moncada R, Demos TC, Churchill R, Reynes C (1983) Chronic stridor in a child: CT diagnosis of pulmonary vascular sling.J Comput Assist Tomogr 7:713–715

    CAS  PubMed  Google Scholar 

  41. Morse HR, Gladding S (1955) Bronchial obstruction due to misplaced left pulmonary artery.Am J Dis Child 89:351–353

    CAS  Google Scholar 

  42. Murphy DR, Dunbar FS, MacEwan DW, Sanchez FR, Perey DYE (1964) Tracheobronchial compression due to a vascular sling.Surg Gynecol Obstet 118:572–578

    CAS  PubMed  Google Scholar 

  43. Mustard WT, Trimble AW, Trusler GA (1962) Mediastinal vascular anomalies causing tracheal and esophageal compression and obstruction in childhood.Can Med Assoc J 87:1301–1305

    CAS  PubMed  Google Scholar 

  44. Neimann N, Manciaux M, Pernot C, Werner J, Vert P (1964) Trajet aberrant de l'artere pulmonaire gauche et stenose bronchique.Arch Fr Pediatr 21:397–411

    CAS  PubMed  Google Scholar 

  45. Nikaidoh H, Riker WL, Idriss FS (1972) Surgical management of “vascular rings”.Arch Surg 105:327–333

    Google Scholar 

  46. Niwayama G (1960) Unusual vascular ring formed by the anomalous left pulmonary artery, with tracheal compression.Am Heart J 59:454–461

    Article  CAS  PubMed  Google Scholar 

  47. Park CD, Waldhausen JA, Friedman S, Aberdeen E, Johnson J (1971) Tracheal compression by the great arteries in the mediastinum: report of 39 cases.Arch Surg 103:626–632

    CAS  PubMed  Google Scholar 

  48. Phelan PD, Venables AW (1978). Management of pulmonary artery sling (anomalous left pulmonary artery arising from right pulmonary artery): a conservative approach.Thorax 33:67–71

    CAS  PubMed  Google Scholar 

  49. Philp T, Sumerling MD, Fleming J, Grainger RG (1972) Aberrant left pulmonary artery.Clin Radiol 23:153–159

    Article  CAS  PubMed  Google Scholar 

  50. Pontius RG (1963) Bronchial obstruction of congenital origin.Am J Surg 106:8–14

    Article  CAS  PubMed  Google Scholar 

  51. Potts WJ, Holinger PH, Rosenblum AH (1954) Anomalous left pulmonary artery causing obstruction to right main bronchus: report of a case.JAMA 155:1409–1411

    CAS  Google Scholar 

  52. Quist-Hanssen S (1949) 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 37:87–94

    Google Scholar 

  53. Raghib G, Ruttenberg HD, Anderson RC, Amplatz K, Adams P Jr, Edwards JE (1965) Termination of left superior vena cava in left atrium, atrial septal defect, and absence of coronary sinus: a developmental complex.Circulation 31:906–918

    CAS  PubMed  Google Scholar 

  54. Rheuban KS, Alford B, Sturgill BC (1982) Pulmonary artery sling: a follow-up [Letter to the editor].Pediatrics 70:655

    CAS  PubMed  Google Scholar 

  55. Rheuban KS, Ayres N, Still JG, Alford B (1982) Pulmonary artery sling: a new diagnostic tool and clinical review.Pediatrics 69:472–475

    CAS  PubMed  Google Scholar 

  56. Rudhe U, Zetterqvist P (1959) Aberrant left pulmonary artery.Acta Chir Scand [Suppl]245:331–335

    Google Scholar 

  57. Sade RM, Rosenthal A, Fellows K, Castaneda AR (1975) Pulmonary artery sling.J Thorac Cardiovasc Surg 69:333–346

    CAS  PubMed  Google Scholar 

  58. Scheid P (1938) Missbildung des Trachealskelettes und der linken Arteria pulmonalis mit Erstickungstod bei 7 Monate altem Kind.Frankfurt Z Path 52:114–124

    Google Scholar 

  59. Schutt WH, Robb PM (1959) Respiratory stridor produced by an aberrant pulmonary artery.Arch Dis Child 34:202–204

    CAS  PubMed  Google Scholar 

  60. Sherman FE (1959) Anomalous course of left pulmonary artery: cause of obstructive emphysema in infants.J Pediatr 54:93–98

    CAS  PubMed  Google Scholar 

  61. Siegel MJ, Shackelford GD, McAlister WH (1982) Tracheobronchography in the evaluation of anomalous left pulmonary artery.Pediatr Radiol 12:235–238

    Article  CAS  PubMed  Google Scholar 

  62. Sprague PL, Kennedy JC (1976) Anomalous left pulmonary artery with an unusual barium swallow.Pediatr Radiol 4:188–189

    CAS  PubMed  Google Scholar 

  63. Stewart JR, Kincaid OW, Edwards JE (1964)An atlas of vascular rings and related malformations of the aortic arch system. Charles C Thomas, Springfield IL, p 171

    Google Scholar 

  64. Stone DN, Bein ME, Garris JB (1980) Anomalous left pulmonary artery: two new adult cases.Am J Roentgenol 135:1259–1263

    CAS  Google Scholar 

  65. Tan PM, Loh TF, Yong NK, Sugai K (1968) Aberrant left pulmonary artery.Br Heart J 30:110–114

    CAS  PubMed  Google Scholar 

  66. Tan-Vinh L, Alagille D, Van Phuoc N (1961) Artere pulmonaire gauche anormale.Arch Fr Pediatr 18:248–262

    Google Scholar 

  67. Tesler UF, Balsara RH, Niguidula FN (1974) Aberrant left pulmonary artery (vascular sling): report of five cases.Chest 66:402–407

    CAS  PubMed  Google Scholar 

  68. Turner AF, Pacuilli JR, Lau FYK, Mikity VG, Johnson JL (1971) Partial tracheal obstruction due to anomalous origin of the left pulmonary artery.Calif Med 114:59–63

    CAS  PubMed  Google Scholar 

  69. Welsh TM, Munro IB (1954) Congenital stridor caused by aberrant pulmonary artery.Arch Dis Child 29:101–103

    CAS  PubMed  Google Scholar 

  70. Williams RG, Jaffe RB, Condon VR, Nixon GW (1979) Unusual features of pulmonary sling.Am J Roentgenol 133:1065–1069

    CAS  Google Scholar 

  71. Wittenborg MH, Tantiwongse T, Rosenberg BF (1956) Anomalous course of left pulmonary artery with respiratory obstruction.Radiology 67:339–345

    PubMed  Google Scholar 

  72. Yeager SB, Chin AJ, Sanders SP (1986) Two-dimensional echocardiographic diagnosis of pulmonary artery sling in infancy.J Am Coll Cardiol 7:625–629

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA

    Betty M. Gikonyo

  2. Department of Pathology, University of Minnesota, Minneapolis, Minnesota, USA

    Jesse E. Edwards

  3. Cardiovascular Department, Valley Children's Hospital, Fresno, California, USA

    Kenneth L. Jue

  4. Jesse E. Edwards Registry of Cardiovascular Disease, United Hospital, Suite 200, St. Paul Heart and Lung Center, 255 North Smith Avenue, 55102, St. Paul, Minnesota, USA

    Jesse E. Edwards

Authors
  1. Betty M. Gikonyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth L. Jue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jesse E. Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gikonyo, B.M., Jue, K.L. & Edwards, J.E. Pulmonary vascular sling: Report of seven cases and review of the literature. Pediatr Cardiol 10, 81–88 (1989). https://doi.org/10.1007/BF02309919

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02309919

Key words

Search

Navigation