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Eur J Cardiothorac Surg 2005;28:900-902
© 2005 Elsevier Science NL

Case report

Coexistence of left pulmonary artery sling and aortopulmonary window complicated with difficult airway—a rare congenital cardiopulmonary defect

^a Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Taiwan, ROC
^b Department of Pediatrics, Kaohsiung Medical University Hospital, Taiwan, ROC

Received 27 June 2005; received in revised form 13 August 2005; accepted 23 August 2005.

^_* Corresponding author. Present address: Department of Pediatrics, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shan-Ming Rd, Hsiao-Kang Dist. 812, Kaohsiung, Taiwan, ROC. Tel.: +886 7 803 6783x3730; fax: +886 7 806 6418. (Email: zenkong{at}kmu.edu.tw).

Both the pulmonary artery sling and the aortopulmonary window are unusual and serious anomalies. In patients with sling the airway might be compromised by associated cartilaginous o-rings in variant segments. In aortopulmonary window the clinical presentations are similar to the large patent ductus arteriosus or ventricular septal defect, but the surgical procedure is quite difficult and different. We operated an infant with a rarely seen cardiac defect, the coexistence of left pulmonary artery sling and Type 3 aortopulmonary window, when he was 35 days old. Postoperative repeated bronchospasm caused prolonged ventilation and hospitalization. Patient was extubated 28 days later and discharged at the age of 80 days without any events. Besides, the reconstructed three-dimensional images of ultrafast computed tomography offered us an interesting view other than surgical findings. A case of two such rare lesions coexisting was not to be found in the literature review, so we report this case because of its rarity and clinical interest.

Key Words: Left pulmonary artery sling • Aortopulmonary window • Bronchospasm • Tracheomalacia • Vascular airway compression