Clinical Analysis Of Surgical Treatment Of 32 Children With Pulmonary Artery Sling

Objective:We aim to investigate the value of imaging examination including echocardiography and MSCT in preoperative diagnosis of PAS and the relationship between different complications of PAS and surgical prognosis.Methods:Collecte and retrospectively analyze the echocardiography,MSCT and clinical data of pediatric patients admitted to our hospital for pulmonary artery sling operation between December 2009 and December 2017.Using Fisher exact probability method to analysis the relationship between complications and prognosis.Using Log-rank survival analysis as the statistical of analyzing the relationship between complications and time of using ventilator after operation.Results:32 cases were diagnosed with pulmonary artery sling by echocardiography or MSCT and confirmed by surgery,including 19 males and 13 females,the median age was 7months 24 days(75 days-42 months),complete pulmonary sling in 31 cases,partial pulmonary sling in 1 case.Thirty-two patients were diagnosed by echocardiography or MSCT before operation.The diagnostic rate of echocardiography combined with MSCT was 100%,5 cases were missed by echocardiography,and 1 case was missed by MSCT.The diagnostic rates were 84.4% and 96.9% respectively.The common comorbidities of the 32 pulmonary slings were airway stenosis(32/32,100.00%),severe airway stenosis(7/32,21.88%),atrial septal defect(12/32,37.50%),patent ductus arteriosus(11/32,34.38%),and bronchial bridge(8/32,25.00%),etc.By analyzing the relationship between complications and prognosis,it was found that children with severe tracheal/bronchial stenosis(OR=21.43,P<0.05) and ring-sling syndrome(OR=5.00,P<0.05) had a worse prognosis.Time of using ventilator after operation was significantly longer in children with severe tracheal/bronchial stenosis than in other children(P<0.05).Discussion:The incidence of males in children with PAS is slightly higher than that in women.96.875% of the children had respiratory symptoms as the first symptom,and 78.125% had the disease before the age of one.The correct rate of PAS diagnosis by MSCT is about 96.875%,and the correct rate of echocardiography diagnosis is 84.375%.The advantage of echocardiography is economical and non-invasive.It can be used as a screening method for PAS.The correct rate of diagnosis of MSCT is high and can be used as a necessary supplement.PAS is commonly associated with ASD(37.5%),PDA(34.4%),permanent left superior vena cava(9.38%),general airway stenosis(78.1%),severe airway stenosis(21.9%),bronchial bridge(25.0%),Tracheal bronchus(9.38%),ring sling syndrome(6.25%) and so on.The prognosis of patients with severe tracheal/bronchial stenosis or ring-sling syndrome was found to be worse.The postoperative time was significantly longer in children with severe tracheal/bronchial stenosis,and the risk of PAS was less affected by cardiovascular malformation.