Effects of medical imaging examinations for diagnosis of pulmonary artery sling before and after delivery

doi:10.3877/cma.j.issn.1673-5250.2019.06.009

Objective

To study effects of medical imaging examinations for diagnosis of children pulmonary artery sling (PAS) before and after delivery.

Methods

From January 2017 to January 2019, a total of 4 children with PAS who were diagnosed by undergoing cardiac surgery in West China Second University Hospital, Sichuan University were selected into this study. Data of medical imaging examinations and clinical manifestations of 4 children with PAS, including fetal echocardiogram, fetal MRI, pediatric echocardiogram and multi-slice spiral CT angiography were analyzed retrospectively. This study was in line with the requirements of World Medical Association of Helsinki revised in 2013.

Results

①Fetal echocardiogram detected difference of long axis section of pulmonary artery, three blood vessels section and three blood vessel-trachea section. The main ultrasonic signs were bifurcation structure of the pulmonary artery disappeared, abnormal left pulmonary artery originated from the right pulmonary artery, the left pulmonary artery traced behind the trachea forming " C" shaped vascular ring. And secondary ultrasonic sign was diameter of the left pulmonary artery was smaller than that of the right pulmonary artery. ② Fetal cardiac MRI revealed the left pulmonary artery arising from the right pulmonary artery and going behind the trachea in the pulmonary artery trunk level. ③ Detections by pediatric echocardiogram were short axis section of the great artery, and its main ultrasonic signs were bifurcation of pulmonary artery disappeared, as well as abnormal left pulmonary artery originated from the right pulmonary artery. ④ Main manifestations of multi-slice spiral CT angiography in children revealed that the left pulmonary artery originated from the right pulmonary artery and traced behind the trachea, and the trachea was compressed.

Conclusions

Diagnosis of fetal PAS mainly depends on fetal echocardiogram, fetal cardiac MRI can provide supplementary diagnosis for ultrasound. Diagnosis of PAS children should be comprehensive evaluation by pediatric echocardiogram, multi-slice spiral CT angiography and other imaging methods.

Key words: Pulmonary artery sling, Ultrasonography, prenatal, Echocardiography, Multi-slice spiral CT, Magnetic resonance imaging, Fetus

图1 肺动脉吊带胎儿(患儿No. 1，孕妇接受胎儿超声心动图检查时孕龄为29^＋5孕周)的胎儿超声心动图(图1A：肺动脉长轴切面的二维图像显示，肺动脉发出右肺动脉，左肺动脉由右肺动脉发出后向气管左后方绕行；图1B：三血管-气管切面的二维图像显示，肺动脉发出右肺动脉，左肺动脉由右肺动脉发出后向气管左后方绕行，形成血管环环绕气管)

图2 肺动脉吊带患儿(患儿No. 4，孕妇接受胎儿心脏MRI检查时孕龄为24^＋5孕周)的胎儿心脏MRI检查结果

图3 肺动脉吊带患儿(患儿No. 2，男性，年龄为生后15 d)的小儿超声心动图

图4 肺动脉吊带患儿(患儿No. 1，男性，年龄为5个月)的小儿多层螺旋CT血管成像(图4A：小儿横轴位增强CT显示，左肺动脉源自右肺动脉，向左后方走行，环绕气管下端，形成"C"形环；图4B：小儿CT三维立体血管成像显示，肺动脉发出右肺动脉，左肺动脉由右肺动脉发出后向左后方绕行，形成"C"形环)

表1 本组4例肺动脉吊带患儿产前及产后医学影像学检查结果

患儿编号(No.)	胎儿超声心动图
患儿编号(No.)	检查时胎龄(周)	心率(次/min)	肺动脉前向血流速度(cm/s)	肺动脉(mm)	左肺动脉(mm)	右肺动脉(mm)	CVP(分)	诊断结果
1	29^＋5	152	0.53	6.7	2.8	3.9	10	PAS
2	23^＋6	148	0.75	6.6	1.5	2.3	10	PAS
3	26^＋3	149	0.49	6.0	2.2	3.0	10	PAS
4	24^＋5	145	0.55	5.8	2.5	5.8	9	PAS、LSVC
患儿编号(No.)	胎儿心脏MRI	小儿多层螺旋CT血管成像				小儿超声心动图
患儿编号(No.)	胎儿心脏MRI	检查时年龄	左肺动脉走行	受压气管内径(mm)	诊断结果	检查时年龄	诊断结果
1	无	生后5个月	气管后方	3.0	完全型PAS	生后44 d	PAS、PDA
2	无	生后1 d	气管后方	3.8	完全型PAS	生后15 d	PAS、PFO
3	无	生后2 d	气管后方	2.0	完全型PAS	生后2 d	PAS、PFO、PDA
4	PAS、LSVC	生后3个月	气管后方	2.0	完全型PAS、LSVC	生后32 d	PAS、PFO、LSVC

表1 本组4例肺动脉吊带患儿产前及产后医学影像学检查结果

患儿编号(No.)	胎儿超声心动图
患儿编号(No.)	检查时胎龄(周)	心率(次/min)	肺动脉前向血流速度(cm/s)	肺动脉(mm)	左肺动脉(mm)	右肺动脉(mm)	CVP(分)	诊断结果
1	29^＋5	152	0.53	6.7	2.8	3.9	10	PAS
2	23^＋6	148	0.75	6.6	1.5	2.3	10	PAS
3	26^＋3	149	0.49	6.0	2.2	3.0	10	PAS
4	24^＋5	145	0.55	5.8	2.5	5.8	9	PAS、LSVC
患儿编号(No.)	胎儿心脏MRI	小儿多层螺旋CT血管成像				小儿超声心动图
患儿编号(No.)	胎儿心脏MRI	检查时年龄	左肺动脉走行	受压气管内径(mm)	诊断结果	检查时年龄	诊断结果
1	无	生后5个月	气管后方	3.0	完全型PAS	生后44 d	PAS、PDA
2	无	生后1 d	气管后方	3.8	完全型PAS	生后15 d	PAS、PFO
3	无	生后2 d	气管后方	2.0	完全型PAS	生后2 d	PAS、PFO、PDA
4	PAS、LSVC	生后3个月	气管后方	2.0	完全型PAS、LSVC	生后32 d	PAS、PFO、LSVC

表2 4例肺动脉吊带患儿的临床特征

患儿编号(No.)	性别	娩出胎龄(周)	娩出方式	出生体重(g)	生后1-5-10 min Apgar评分(分)	呼吸系统症状	心脏杂音	合并心外畸形	手术方式	接受手术时年龄(月)
1	男	37	自然分娩	2 600	9-10-10	气促、喘鸣	无	尿道下裂	PAS矫治术	8
2	男	39	自然分娩	2 670	9-10-10	气促、喘鸣	无	无	PAS矫治术	5
3	男	37	剖宫产术分娩	2 340	8-10-10	气促	无	无	PAS矫治术	6
4	男	38	自然分娩	2 700	9-10-10	反复肺炎	无	无	PAS矫治术＋支气管成形术	11

表2 4例肺动脉吊带患儿的临床特征

患儿编号(No.)	性别	娩出胎龄(周)	娩出方式	出生体重(g)	生后1-5-10 min Apgar评分(分)	呼吸系统症状	心脏杂音	合并心外畸形	手术方式	接受手术时年龄(月)
1	男	37	自然分娩	2 600	9-10-10	气促、喘鸣	无	尿道下裂	PAS矫治术	8
2	男	39	自然分娩	2 670	9-10-10	气促、喘鸣	无	无	PAS矫治术	5
3	男	37	剖宫产术分娩	2 340	8-10-10	气促	无	无	PAS矫治术	6
4	男	38	自然分娩	2 700	9-10-10	反复肺炎	无	无	PAS矫治术＋支气管成形术	11

[1]	Collell R, Marimón C, Montero M. Partial left pulmonary artery sling [J]. Rev Esp Cardiol, 2010, 63(7): 850.
[2]	Evans WN, Acherman RJ, Ciccolo ML, et al. Vascular ring diagnosis and management: notable trends over 25 years [J]. World J Pediatr Congenit Heart Surg, 2016, 7(6): 717-720.
[3]	Oshima Y, Yamaguchi M, Yoshimura N, et al. Management of pulmonary artery sling associated with tracheal stenosis [J]. Ann Thorac Surg, 2008, 86(4): 1334-1338.
[4]	Bonnard A, Auber F, Fourcade L, et al. Vascular ring abnormalities: a retrospective study of 62 cases [J]. J Pediatr Surg, 2003, 38(4): 539-543.
[5]	Fiore AC, Brown JW, Weber TR, et al. Surgical treatment of pulmonary artery sling and tracheal stenosis [J]. Ann Thorac Surg, 2005, 79(1): 38-46; discussion 38-46.
[6]	Giudici V, Kanani M, Muthialu N, et al. Duplicated left pulmonary artery: an unknown disease? Three case reports and review of the literature [J]. Cardiol Young, 2016, 26(2): 340-346.
[7]	Silahli M, Ozkiraz S, Gokdemir M, et al. A pulmonary artery sling and in vitro fertilization [J]. J Bronchology Interv Pulmonol, 2017, 24(1): e6-e8.
[8]	Yao M, Li Y, Ali SI, et al. Clinical and imaging features of pulmonary artery sling: the experience in one major medical center [J]. Echocardiography, 2018, 35(8): 1237-1242.
[9]	曲海波，宁刚，赵福敏，等. 肺动脉吊带畸形1例 [J/CD]. 中华妇幼临床医学杂志(电子版)，2012，8(5)：669.
[10]	朱清於，金崇厚．先天性心脏病病理解剖学 [M]. 北京：人民军医出版社，2001：290.
[11]	Li XL, Li X, Saul D, et al. Fetal MRI diagnosis of 2 types of left pulmonary artery sling [J]. Radiol Case Rep, 2017, 12(4): 653-657.
[12]	Gikonyo BM, Jue KL, Edwards JE. Pulmonary vascular sling: report of seven cases and review of the literature [J]. Pediatr Cardiol, 1989, 10(2): 81-89.
[13]	Healey D, Ron N, Hromada A, et al. Perinatal/neonatal case presentation: pulmonary artery sling associated with respiratory distress [J]. Springerplus, 2016, 5: 31.
[14]	Binsalamah ZM, Fraser CD, Mery CM. A pulmonary artery sling with a vascular ring in a toddler: an uncommon combination [J]. Cardiol Young, 2018, 28(5): 783-785.
[15]	Ghandi Y, Shafiee A, Sharifi M, et al. A rare case of pulmonary artery sling with the VACTERL association in a 20-month-old infant [J]. J Tehran Heart Cent, 2017, 12(3): 131-133.
[16]	Lee JW, Printz BF, Hegde SR, et al. Double trouble: fetal diagnosis of a pulmonary artery sling and vascular ring [J]. Clin Case Rep, 2016, 4(12): 1187-1190.
[17]	Vu HV, Huynh QK, Nguyen VDQ. Surgical reconstruction for congenital tracheal malformation and pulmonary artery sling [J]. J Cardiothorac Surg, 2019, 14(1): 49.
[18]	Wang KL, Fu YC, Chan SC, et al. " Uneven-sized eyes" sign on echocardiography in a young girl with pulmonary artery sling and tracheal bronchus [J]. Acta Cardiologica, 2017, 72(1): 81-82.
[19]	Weber A, Donner B, Perez MH, et al. Complicated Postoperative Course after pulmonary artery sling repair and slide tracheoplasty [J]. Front Pediatr, 2017, 5: 67.
[20]	Sezer S, Acar DK, Ekiz A, et al. Prenatal diagnosis of left pulmonary artery sling and review of literature [J]. Echocardiography, 2019, 36(5): 1001-1004.
[21]	安鹏，王瑜，宁雨欣，等. 5例肺动脉吊带的产前超声及产后CT特征 [J]. 中国现代医学杂志，2019, 29(6): 120-124.
[22]	Xie J, Juan YH, Wang Q, et al. Evaluation of left pulmonary artery sling, associated cardiovascular anomalies, and surgical outcomes using cardiovascular computed tomography angiography [J]. Sci Rep, 2017, 7: 40042.
[23]	Smith FW, Adam AH, Phillips WD. NMR imaging in pregnancy [J]. Lancet, 1983, 1(8314-5): 61-62.
[24]	Roy CW, van Amerom JFP, Marini D, et al. Fetal cardiac MRI: a review of technical advancements [J]. Top Magn Reson Imaging, 2019, 28(5): 235-244.
[25]	van Amerom JFP, Lloyd DFA, Deprez M, et al. Fetal whole-heart 4D imaging using motion-corrected multi-planar real-time MRI [J]. Magn Reson Med, 2019, 82(3): 1055-1072.
[26]	Nakajima J, Sunohara D, Kawashima H. A case of pulmonary artery sling where onset was induced by therapeutic hypothermia [J]. Pediatr Pulmonol, 2017, 52(3): E7-E10.
[27]	Haponiuk I, Chojnicki M, Paczkowski K, et al. Pulmonary artery sling diagnosed and corrected in an 11-year-old boy with refractory pulmonary infections and childhood-onset asthma [J]. Kardiochir Torakochirurgia Pol, 2018, 15(3): 207-208.
[28]	Lim GB. Improved visualization of fetal heart abnormalities with 3D MRI [J]. Nat Rev Cardiol, 2019, 16(7): 386.
[29]	Shi K, Gao HL, Yang ZG, et al. Dual-source computed tomography for quantitative assessment of tracheobronchial anomaly from type ⅡA pulmonary artery sling in pediatric patients [J]. Eur J Radiol, 2018, 102: 30-35.
[30]	Espinoza J. Fetal MRI and prenatal diagnosis of congenital heart defects [J]. Lancet, 2019, 393(10181): 1574-1576.
[31]	Leonardi B, Secinaro A, Cutrera R, et al. Imaging modalities in children with vascular ring and pulmonary artery sling [J]. Pediatr Pulmonol, 2015, 50(8): 781-788.
[32]	Han Y, Yin Q, Wang Y, et al. Three-dimensional printed degradable splint in the treatment of pulmonary artery sling associated with severe bilateral bronchus stenosis [J]. Cardiol Young, 2018, 28(12): 1477-1480.

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