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Recurrent pulmonary haemorrhage in an infant with tetralogy of Fallot and absent pulmonary valve: interventional treatment by coil occlusion of systemic-to-pulmonary collateral arteries

Published online by Cambridge University Press:  17 July 2012

Matthias Kumpf ,
Jürgen Schäfer  and
Michael Hofbeck
Matthias Kumpf*
Affiliation:
Department of Pediatric Cardiology, Pulmology and Intensive Care, Tuebingen, Germany
Jürgen Schäfer
Affiliation:
Department of Paediatric Radiology, Universitaets Klinikum Tuebingen, Tuebingen, Germany
Michael Hofbeck
Affiliation:
Department of Pediatric Cardiology, Pulmology and Intensive Care, Tuebingen, Germany
*
Correspondence to: Dr. med. Matthias Kumpf, Universitaetsklinikum Tuebingen, Department Kinderheilkunde II, Hoppe-Seyler Strasse 3, D-72076 Tuebingen, Germany. Tel: +49 7071 2986611; Fax: +49 7071 295804; E-mail: matthias.kumpf@med.uni-tuebingen.de
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Abstract

Although clinically silent in the majority of cases, enlarged bronchial arteries or systemic-to-pulmonary collateral arteries may complicate congenital heart disease in infants, causing significant left-to-right shunting with subsequent pulmonary congestion and respiratory compromise. So far, pulmonary haemorrhage, a well-known complication in older patients with cyanotic congenital heart disease, has not been described in infancy. We describe the case of a 6-month-old girl with tetralogy of Fallot and absent pulmonary valve who developed haemoptysis with severe respiratory distress following corrective surgery of the cardiac malformation. High-resolution computed tomography of the thorax followed by selective angiography revealed a systemic-to-pulmonary collateral artery originating from the left internal mammary artery. Pulmonary haemorrhage stopped immediately following coil occlusion of the collateral. A second episode of pulmonary haemorrhage occurred at the age of 9 months during mechanical ventilation for treatment of pneumonia. Repeat angiography revealed two more collateral vessels. Again coil occlusion resulted in prompt resolution of pulmonary haemorrhage. According to our experience, enlarged bronchial arteries or systemic-to-pulmonary collateral arteries should be considered in infants with cyanotic heart disease with unexplained pulmonary congestion or prolonged respiratory problems.

Keywords

Tetralogy of Fallotabsent pulmonary valvemayor aorto-pulmonary arteryinterventionhaemoptysis
Type
Brief Reports
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 443 - 446
Copyright
Copyright © Cambridge University Press 2012 

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