Collateral Occlusion as a Treatment Modality for Hemoptysis

Abstract

Large cardiac shunts such as ventricular septal defects (VSD) and patent ductus arteriosus (PDA) if left untreated can cause severe pulmonary hypertension and reversal of cardiac shunting leading to Eisenmenger’s syndrome. This in turn causes hypoxia. These patients may be hypoxic for years or even decades, as a consequence of chronic hypoxia and altered pulmonary blood flow, this population frequently develops significant systemic-to-pulmonary collateral arteries (SPCs), providing a secondary source of pulmonary blood flow. These collaterals can cause hemoptysis with life-threatening airway bleeding, which may be a pathologic sequela of SPCs. Hemoptysis can have multiple causes usually categorized under parenchymal diseases, airway diseases, and vascular diseases. Endovascular embolization is been used increasingly for managing such high-risk patients presenting with hemoptysis. Here we discuss a patient with uncorrected congenital VSD with severe pulmonary hypertension and with right to left shunt who presented with hemoptysis and SPCs.