Bronchoscopy-Guided Catheter Interventional Closure of Ruptured Major Aortopulmonary Collateral Arteries as a Cause of Acute Hemoptysis

Background: Major aortopulmonary collateral arteries (MAPCAs) are vessels connecting the aorta or its branches to the pulmonary arteries, thereby providing either excessive or required pulmonary blood flow. They are often seen in patients with cyanotic congenital heart defects. Ruptured MAPCAs bear the risk of life-threatening pulmonary hemorrhage. High variability in anatomical origin and course may prolong localization and subsequent interventional closure.

Method: We report two cases of acute hemoptysis due to ruptured MAPCAs in patients with congenital heart defect. The first patient is a 24-year-old female with history of unbalanced atrioventricular septal defect after total cavopulmonary connection (TCPC) surgery, who was referred to our clinic with acute pulmonary hemorrhage, occurring during bronchoscopy, as part of the diagnostic workup of hemoptysis. The second patient is a 13-year-old female with history of congenital corrected TGA, pulmonary atresia, and perimembranous ventricular septal defect (PA/VSD) and TCPC palliation, with acute hemoptysis. Upon admission to the cath-lab, both patients were in stable condition. Primary bronchoscopy could localize the bleeding site. The ruptured collateral arteries could then be precisely located by angiography and interventionally closed.

Conclusion: Angiographic localization of ruptured MAPCAs remains challenging, especially during acute pulmonary bleeding and in the presence of multiple, diffuse collateralization. Our cases demonstrate the benefits of bronchoscopic guidance to achieve rapid localization and closure of the ruptured MAPCAs. In contrast to current guidelines, we find simultaneous performance of bronchoscopy and cardiac catheterization to be advantageous, reducing radiation and contrast media exposure and optimizing crucial time to closure.

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Artikel online veröffentlicht:
28. Januar 2023