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Catastrophic haemoptysis in the Fontan circulation – a novel surgical approach to denude the culprit bleeding vessels

Published online by Cambridge University Press:  25 February 2011

David E. Black
Affiliation:
Department of Adult Congenital Heart disease and Interventional Radiology, Southampton University Hospital, Southampton, United Kingdom
Gruschen R. Veldtman*
Affiliation:
Department of Adult Congenital Heart disease and Interventional Radiology, Southampton University Hospital, Southampton, United Kingdom
Timothy Bryant
Affiliation:
Department of Adult Congenital Heart disease and Interventional Radiology, Southampton University Hospital, Southampton, United Kingdom
John Miller
Affiliation:
Department of Adult Congenital Heart disease and Interventional Radiology, Southampton University Hospital, Southampton, United Kingdom
Marcus Haw
Affiliation:
Department of Adult Congenital Heart disease and Interventional Radiology, Southampton University Hospital, Southampton, United Kingdom
*
Correspondence to: Dr G. R. Veldtman, Department of Adult Congenital Heart disease and Interventional Radiology, Southampton University Hospital, Southampton, United Kingdom. Tel: 02380 79 6055; Fax: 02380 79 4523; E-mail: [email protected]

Abstract

We describe the case of a young man aged 19 years with a double inlet left ventricle associated with transposition of the great arteries, and a mechanical aortic valve requiring anticoagulation, who presented with massive haemoptysis. At cardiac catheterisation, there were multiple feeder vessels to a bleeding leash surrounding and communicating with his left main bronchus. Despite occlusion of the larger feeder vessels, he continued to have massive haemoptysis. We describe a novel surgical strategy of denuding the peribronchial vessels through a left lateral thoracotomy. This successfully stopped his bleeding.

Type
Brief Reports
Copyright
Copyright © Cambridge University Press 2011

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References

1.Gewillig, M. The Fontan circulation. Heart 2005; 91: 839846.CrossRefGoogle ScholarPubMed
2.Suda, K, Matsumura, M, Sano, A, et al. Haemoptysis from collateral arteries 12 years after a Fontan-Type operation. Ann Thorac Surg 2005; 79: 78.CrossRefGoogle ScholarPubMed
3.Deisenberg, M, Stayer, SA. Severe haemoptysis in a child after the Fontan procedure. Paediatr Anaesth 2005; 15: 515518.CrossRefGoogle Scholar
4.El-Melegy, NT, Mohamed, NA. Angiogenic biomarkers in children with congenital heart disease: possible implications. Ital J paediatr 2010; 36: 32.CrossRefGoogle ScholarPubMed
5.Suda, K, Matsumura, M, Miyanish, S, et al. Increased VEGF in patients with cyanotic congenital heart disease may not be normalized after a Fontan type operation. Ann Thorac Surg 2004; 78: 942946.CrossRefGoogle Scholar
6.Brinson, GM, Noone, PG, Mauro, MA, et al. Bronchial artery embolization for the treatment of haemoptysis in patients with cystic fibrosis. Am J Respir Crit Care Med 1998; 157: 19511958.CrossRefGoogle ScholarPubMed
7.Shigemura, N, Wan, IY, Yu, SCH, et al. Multidisciplinary management of life-threatening massive haemoptysis: a 10 year experience. Ann Thorac Surg 2009; 87: 849853.CrossRefGoogle ScholarPubMed
8.Ferrara, N, Hillan, KJ, Novotny, W. Bevacizumab (Avastin), a humanized anti-VEGF monoclonal antibody for cancer therapy. Biochem Biophys Res Commun 2005; 333: 328335.CrossRefGoogle ScholarPubMed