Left bronchial compression after an arterial switch operation with the LeCompte maneuver for transposition of the great arteries: A case report and literature review

Abstract

Left bronchial compression is a rarely reported, postoperative complication of the arterial switch operation with the LeCompte maneuver for transposition of the great arteries. Postoperative neopulmonary root dilatation and the anterior-posterior, anatomical relationship of the great vessels may cause this condition. Hypoxic pulmonary vasoconstriction may mask the condition even if the left bronchus has been severely obstructed. The apparent inconsistency between the abnormally decreased pulmonary blood flow and the absence of any irregularities in the vascular structure that might account for it suggested hypoxic pulmonary vasoconstriction to be the cause. We present herein a case of left bronchial compression presenting malacia after an arterial switch operation with the LeCompte maneuver and also present a review of seven, other, reported cases.

Learning objectives: Left bronchial compression is a rare complication of the arterial switch operation with the LeCompte maneuver for transposition of the great arteries and is possibly caused by root dilatation and the anatomical relationship of the great vessels. Hypoxic pulmonary vasoconstriction may mask the condition.

Keywords: Arterial switch operation with the LeCompte maneuver; Hypoxic pulmonary vasoconstriction; Left bronchial compression; Transposition of the great arteries.

Fig. 1

Diagnostic images of the present case before and after ASO/L. (a) Chest X-ray image at postoperative month 3. The vascularity of the left lung is markedly reduced. (b) Pulmonary perfusion scintigraphy of the posterior projection at postoperative month 4. The perfusion distribution was 93 % in the right lung and 7 % in the left lung. (c) Three-dimensional volume rendering with computed tomography image reconstruction at postoperative month 4. Note the prominent main pulmonary artery dilatation with branch pulmonary artery stenosis on the right side. Left bronchial compression by the ascending aorta (arrow head), which appears to curve concave anteriorly due to compression by the dilated main pulmonary artery, was observed. (d) Axial computed tomography of the present case before and after ASO/L. Note the left bronchus (arrow head) is completely patent before ASO/L but almost entirely occluded after the procedure. (e) Echocardiographic image at postoperative month 4. Note the ‘to and fro’ flow of the left pulmonary artery (found on retrospective inspection of the imaging findings after re-operation), which was not seen on the right side. AAo, ascending aorta; ASO/L, arterial switch operation with the LeCompte maneuver; LPA, left pulmonary artery; MPA, main pulmonary artery; RPA, right pulmonary artery.