JACC. Case reports · 2026
Selective Hemostasis in Repaired Tetralogy of Fallot With an Absent Left Pulmonary Artery: The Bleeding Lifeline.
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Lone Muzamil Yousuf, Sharma Sheetal, Sasikumar Deepa, V Jineesh, P Stalin John, Ratnjeet Kumar, Nagesh Sharath, George Deepak, Gopalakrishnan Arun
Аннотация
BACKGROUND: Hemoptysis after repair of tetralogy of Fallot is uncommon and should prompt evaluation for residual pulmonary arterial lesions, infection, and systemic-to-pulmonary collaterals.
CASE SUMMARY: A 30-year-old woman with repaired tetralogy-type anatomy and an absent left pulmonary artery presented 5 months after intracardiac repair with hemoptysis. Postoperative computed tomographic angiography showed an absent/nonvisualized left pulmonary artery, a small focal hemorrhagic opacity in the left lower lung, and systemic collateral supply from the descending thoracic aorta and left inferior phrenic artery. Selective inferior phrenic angiography demonstrated hypertrophied feeders to the left lower lung with abnormal parenchymal blush. Superselective coil embolization of the culprit feeder achieved flow stasis and reduced blush; other collaterals were preserved to avoid pulmonary infarction.
DISCUSSION: In unilateral absence of a pulmonary artery, collaterals may be both the bleeding source and the lung's functional blood supply.
TAKE-HOME MESSAGE: Management should target the culprit bleeding feeder rather than obliterating all collaterals.
CASE SUMMARY: A 30-year-old woman with repaired tetralogy-type anatomy and an absent left pulmonary artery presented 5 months after intracardiac repair with hemoptysis. Postoperative computed tomographic angiography showed an absent/nonvisualized left pulmonary artery, a small focal hemorrhagic opacity in the left lower lung, and systemic collateral supply from the descending thoracic aorta and left inferior phrenic artery. Selective inferior phrenic angiography demonstrated hypertrophied feeders to the left lower lung with abnormal parenchymal blush. Superselective coil embolization of the culprit feeder achieved flow stasis and reduced blush; other collaterals were preserved to avoid pulmonary infarction.
DISCUSSION: In unilateral absence of a pulmonary artery, collaterals may be both the bleeding source and the lung's functional blood supply.
TAKE-HOME MESSAGE: Management should target the culprit bleeding feeder rather than obliterating all collaterals.