Pulmonary artery sling with complete tracheal rings represents a rare and challenging congenital anomaly, particularly in premature infants. We present a case of successful repair in an extremely low-weight premature infant.

A male premature infant (34 weeks of gestation, birth weight 1820 g) was diagnosed prenatally with pulmonary artery sling, perimembranous ventricular septal defect, and patent ductus arteriosus. At one month of age, bronchoscopy revealed severe tracheal stenosis with complete tracheal rings (3.1 mm external diameter). Despite the high surgical risk due to low body weight, complete surgical repair was performed at 2.7 kg through median sternotomy under cardiopulmonary bypass. The procedure included pulmonary artery sling repair with autologous pericardial augmentation, slide tracheoplasty using interrupted everted 6-0 PDS sutures, ventricular septal defect closure, and patent ductus arteriosus ligation. Intraoperative bronchoscopy confirmed adequate airway patency.

This case demonstrates that successful complete repair of complex cardiac and airway anomalies can be achieved in premature, low-weight infants when conventional weight gain thresholds cannot be met. Key factors for success include meticulous surgical technique, precise cardiopulmonary bypass management, careful perioperative care optimisation, and a multidisciplinary approach. While body weight alone should not be an absolute contraindication for surgical intervention, careful patient selection and appropriate institutional expertise are essential.