Prediction of pulmonary artery sling in children using echocardiography: scoring based on pulmonary artery bifurcation and pulmonary valve ring distance.

Objective: To analyze the echocardiography characteristics of pulmonary artery sling (PAS) and explore the diagnostic value of the distance between the bifurcation of the left and right pulmonary arteries and the pulmonary artery valve annulus (DBP) in diagnosing PAS in children.

Methods: This retrospective study analyzed echocardiographic data from 27 children diagnosed with PAS at our hospital from March 2014 to December 2022. The data were compared with those from 77 normal children. The study examined statistical differences between the two groups in the diameters of the left and right pulmonary arteries, the main pulmonary artery valve annulus diameter, and the DBP, both uncorrected and corrected for body surface area (BSA). The diagnostic utility of these measurements for distinguishing children with PAS from those without was assessed using receiver operating characteristic (ROC) curves.

Results: The DBP and the corrected DBP values were significantly higher in the PAS group than in the normal group, with areas under the ROC curve of 0.909 for DBP and 0.951 for DBP/BSA (P < 0.05). A DBP of 1.87 cm as the diagnostic threshold yielded a sensitivity of 98.9% and specificity of 84.4%. A DBP/BSA of 7.68 cm/m² had a sensitivity of 98.3% and specificity of 92.2%. The diagnostic odds ratios (OR) were 76.38% and 79.99%, respectively.

Conclusion: The pivotal element in echocardiography diagnosis of PAS is the identification of the spatial relationship between the left pulmonary artery (LPA) and the trachea. The use of quantitative indices such as DBP and DBP/BSA for adjunctive diagnosis can positively impact the early detection of PAS.