Airway management and transesophageal echocardiographic monitoring for pulmonary artery sling

Pulmonary artery sling is an uncommon vascular anomaly and can be life thre atening when it causes tracheal compression. We report on a 14-day-old boy who presented with respiratory distress soon after birth. A series of exami nations showed tracheal stenosis due to a pulmonary artery sling. Surgery w as performed with the aid of cardiopulmonary bypass. The external compressi on and intrisic stenosis could not be resolved by vascular surgery because of tracheal malacia and a complete tracheal ring. We recommend cutting extr a holes 1 to 2 cm from the distal end of the endotracheal tube for endobron chial intubation. The airway obstruction was resolved successfully with a c ustom-made endobronchial tube. However, the patient died of pneumomediastin um and pneumothorax induced by barotrauma, on the fourth postoperative day.