Transcatheter closure of anomalous systemic arterial supply to the left lung from the left subclavian artery: Diagnostic and procedural challenges.

UNLABELLED: A 26-year-old woman with chronic effort intolerance and a continuous murmur underwent evaluation for suspected congenital heart disease. While initial assessments raised suspicion for a patent ductus arteriosus, computed tomography pulmonary angiography confirmed a rare systemic arterial collateral originating from the left subclavian artery and supplying the left lung. Due to significant left heart chamber dilatation, transcatheter closure was undertaken. A 20-mm vascular plug was successfully deployed to occlude the primary collateral. However, during attempted closure of an additional undetected collateral, sheath migration resulted in vascular dissection and intrapulmonary hemorrhage. The patient required mechanical ventilation, blood transfusion, and intercostal drainage. Hemostasis happened with clot formation at the bleeding site, and the patient gradually stabilized. She was discharged in good clinical condition after seven days. This case underscores the diagnostic and procedural challenges associated with anomalous systemic arterial supply to the lung. It highlights the potential for serious complications despite minimally invasive approaches and emphasizes the critical role of multidisciplinary collaboration in ensuring successful outcomes.

LEARNING

OBJECTIVE

To recognize anomalous systemic arterial supply to the lung as a rare but important differential in patients with unexplained continuous murmurs and left heart dilatation, understand the role of advanced imaging in diagnosis, and appreciate the challenges and potential complications of transcatheter closure. This case also emphasizes the importance of multidisciplinary collaboration in managing complex vascular anomalies and ensuring patient safety during high-risk interventions.