Embolization of systemic to pulmonary artery collaterals in the management of hemoptysis in pulmonary atresia

Massive hemoptysis is a rare but potentially lethal complication in cyanotic patients with pulmonary atresia.¹ Most such patients are adolescents or young adults who have not had total correction of their cardiac defects but who have survived because of abundant systemic to pulmonary artery collateral vessels. Ironically, hemoptysis is believed in most cases to be due to endobronchial rupture of these enlarged collaterals. Major episodes of hemoptysis are a significant problem in the management of these patients, whose cardiac and pulmonary function may be tenuous. Transcatheter bronchial artery embolization has been used to treat severe hymoptysis due to a variety of causes. Hemoptysis secondary to cystic fibrosis, bronchiectasis, tuberculosis, aspergillomas and other origins may be controlled in approximately 90% of patients by embolic therapy.^2-5 There are no reports however, in English of use of transcatheter embolization to control hemoptysis in patients with pulmonary atresia bleeding from enlarged systemic to pulmonary artery collateral vessels.