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Background <p>Pulmonary artery sling (PAS) is a rare congenital anomaly of the great vessels, often accompanied by tracheal stenosis and various intracardiac malformations. Traditionally, PAS surgeries have been performed using tracheal intubation and extracorporeal circulation. In 2015, our center began using laryngeal mask airway (LMA) ventilation combined with extracorporeal circulation to facilitate PAS surgeries. This study retrospectively analyzed the outcomes of LMA ventilation and compared them with those of traditional tracheal intubation.</p> Methods <p>A retrospective analysis was conducted on PAS surgery cases from January 2010 to December 2021. Data collected included intraoperative ventilation methods, postoperative ventilator support time, postoperative respiratory reinterventions, extracorporeal circulation time, surgery duration, tracheal stenosis degree (T)/left pulmonary artery stenosis degree (P), intensive care unit (ICU) stay duration, and postoperative hospital stay duration. The T/P ratio was calculated through preoperative imaging evaluations.</p> Results <p>Thirty-nine PAS surgery cases were analyzed, with a mean age at surgery of 14.2 ± 13.7 months (range: 1.2 months to 4.8 years) and a mean weight of 9.0 ± 3.7&#xa0;kg (range: 3.8–17.9&#xa0;kg). Eleven patients (28.2%) had concurrent cardiac malformations. Patients were divided into the LMA group (14 cases) and the tracheal intubation group (25 cases) based on intraoperative ventilation methods. The LMA group included three patients with concurrent intracardiac malformations (all atrial septal defects). Compared with the tracheal intubation group, the LMA group had a significantly shorter extracorporeal circulation time, lower tracheal stenosis degree (T)/left pulmonary artery stenosis degree (P), shorter postoperative ventilator support time, and ICU stay duration. The LMA group also included older patients.</p> Conclusion <p>LMA ventilation is a feasible and effective option for ventilation management during surgeries in select patients with PAS, particularly those who are older, have milder symptoms, have less severe tracheal stenosis, have smaller T/P ratios, and may or may not have simple intracardiac malformations with good cardiac function. LMA ventilation was associated with shorter ICU and hospital stays, suggesting it may serve as a reasonable alternative for selected children with pulmonary artery sling (PAS).</p>

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Feasibility of laryngeal mask airway ventilation in selected pediatric pulmonary artery sling surgeries: a retrospective review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月23日

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  • Xiao Shen,
  • Fan Zhang,
  • HuiFeng Zhang,
  • Ming Ye

摘要

Background

Pulmonary artery sling (PAS) is a rare congenital anomaly of the great vessels, often accompanied by tracheal stenosis and various intracardiac malformations. Traditionally, PAS surgeries have been performed using tracheal intubation and extracorporeal circulation. In 2015, our center began using laryngeal mask airway (LMA) ventilation combined with extracorporeal circulation to facilitate PAS surgeries. This study retrospectively analyzed the outcomes of LMA ventilation and compared them with those of traditional tracheal intubation.

Methods

A retrospective analysis was conducted on PAS surgery cases from January 2010 to December 2021. Data collected included intraoperative ventilation methods, postoperative ventilator support time, postoperative respiratory reinterventions, extracorporeal circulation time, surgery duration, tracheal stenosis degree (T)/left pulmonary artery stenosis degree (P), intensive care unit (ICU) stay duration, and postoperative hospital stay duration. The T/P ratio was calculated through preoperative imaging evaluations.

Results

Thirty-nine PAS surgery cases were analyzed, with a mean age at surgery of 14.2 ± 13.7 months (range: 1.2 months to 4.8 years) and a mean weight of 9.0 ± 3.7 kg (range: 3.8–17.9 kg). Eleven patients (28.2%) had concurrent cardiac malformations. Patients were divided into the LMA group (14 cases) and the tracheal intubation group (25 cases) based on intraoperative ventilation methods. The LMA group included three patients with concurrent intracardiac malformations (all atrial septal defects). Compared with the tracheal intubation group, the LMA group had a significantly shorter extracorporeal circulation time, lower tracheal stenosis degree (T)/left pulmonary artery stenosis degree (P), shorter postoperative ventilator support time, and ICU stay duration. The LMA group also included older patients.

Conclusion

LMA ventilation is a feasible and effective option for ventilation management during surgeries in select patients with PAS, particularly those who are older, have milder symptoms, have less severe tracheal stenosis, have smaller T/P ratios, and may or may not have simple intracardiac malformations with good cardiac function. LMA ventilation was associated with shorter ICU and hospital stays, suggesting it may serve as a reasonable alternative for selected children with pulmonary artery sling (PAS).