Three-dimensional tracheal morphologic changes after left pulmonary artery sling repair with and without tracheoplasty.

PURPOSE: In patients with a left pulmonary artery sling (LPAS) and congenital tracheal stenosis, indications for simultaneous slide tracheoplasty remain controversial. This study quantified three-dimensional tracheal morphologic changes after LPAS repair with and without slide tracheoplasty to provide insights into establishing surgical indications. METHODS: Airway geometries were reconstructed from pre- and postoperative computed tomography scans in 13 patients (10 with tracheoplasty, three with LPAS repair alone), measuring equivalent diameter and geometry-based flow resistance in a 30-mm segment proximal to the carina. All results are expressed as median [range]. RESULTS: The tracheoplasty group showed significant pericarinal enlargement (3.3 [2.4-4.1] to 5.2 [4.2-6.7] mm; P = 0.002) and a marked decrease in resistance estimates (2.30 [0.83-9.6] to 0.39 [0.11-1.88] cmH2O/(L/s); P = 0.004). In the LPAS repair alone group, two patients exhibited low preoperative resistance estimates (0.92 and 1.52 cmH2O/(L/s)), comparable to postoperative values in the tracheoplasty group. CONCLUSION: Slide tracheoplasty provides substantial morphologic and functional improvements, but certain patients achieve acceptable airway resistance with LPAS repair alone. Computational flow resistance may represent a useful tool for visualizing or quantifying the effects of surgical intervention.