Percutaneous occlusion of a pulmonary aneurysm causing hemoptysis in a patient with pulmonary atresia and aortopulmonary collaterals

Abstract

A 28-year-old male was referred for cardiac catheterization because of recurrent severe hemoptysis necessitating resuscitation and subsequently preventing weaning from ventilation. He had a history of pulmonary atresia, ventricular septal defect, overriding aorta with right-sided aortic arch diagnosed at birth. Eisenmenger's syndrome ensued and he was not felt to be suitable for corrective cardiac surgery. He had multiple major aortopulmonary collateral vessels to both lungs with a large aneurysm in an artery to the right lower lobe, which was suspected to be the source of his bleeding. Occlusion of this aneurysm was achieved percutaneously using an Amplatzer septal occluder device. He had no further bleeding and was successfully weaned from ventilation. Six months later, he has recovered to his functional baseline and has not had any further episodes of hemoptysis.

Indications for the use of the Amplatzer vascular plug in interventional radiology

“…The AVP grew out of two cardiac devices used for the closure of interatrial defects or patent ductus arteriosus (the Amplatzer septal occluder and the Amplatzer duct occluder, respectively) [1,2]. The AVP in now indicated for the occlusion of medium-to small-size arteries or veins in interventional radiology [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Over the past year, a number of early reports have been published in the literature (Table 1). These are mostly case reports regarding extracardiac applications of the Amplatzer systems for treating pulmonary AVM [4,7,9,13], subclavian [8], internal iliac [6,14], pulmonary [12] and cerebral aneurysms [5], for the occlusion of a retroperitoneal shunt in a patient with portal hypertension during transjugular intrahepatic portosystemic shunt (TIPS) creation [3] and for the occlusion of the internal iliac artery in patients with aortoiliac or iliac aneurysm [11]. One of the earliest reports described the use of the AVP to occlude the origin of the internal iliac artery in the endovascular treatment of aortoiliac and iliac aneurysms to prevent type II endoleaks [11].…”

“…Among later studies, a sporadic report of a ruptured isolated aneurysm of the internal iliac artery [14] described embolisation of the outflow branches and the origin of the internal iliac artery with coils and an AVP using the endue precursori per utilizzo esclusivo in ambito cardiologico per la chiusura dei difetti interatriali o dei dotti arteriosi pervii (Amplater Septal Occluder e l'Amplatzer Duct Occluder rispettivamente) [1,2]. Il VPA trova oggi indicazione in radiologia interventistica nell'occlusione di arterie o vene di medio e piccolo calibro [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…The device grew out of two precursors designed exclusively for cardiological purposes, the Amplatzer septal occluder and the Amplatzer duct occluder, used for the occlusion of interatrial defects and patent ductus arteriosus, respectively [1,2]. The system's plug-like shape and availability in several sizes have progressively expanded its applications in interventional radiology, where it offers an alternative to permanent embolising material such as metallic coils or acrylic glue, in the occlusion of small-to mediumsize feeding and draining vessels in the treatment of aneurysms or arteriovenous malformations (AVM) [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Il dispositivo è nato da due precursori per utilizzo esclusivo in ambito cardiologico, l'Amplater Septal Occluder e l'Amplatzer Duct Occluder, per l'occlusione rispettivamente dei difetti interatriali e dei dotti arteriosi pervi [1,2]. Le caratteristiche morfologiche "a tappo" e la disponibilità in più diametri ne hanno progressivamente ampliato le indicazioni specie in radiologia interventistica, in alternativa all'utilizzo di materiale embolizzante di tipo definitivo, quali spirali metalliche o la colla acrilica, nell'occlusione di afferenze o efferenze di arterie e vene di piccolo e medio calibro per il trattamento della patologia aneurismatica o delle malformazioni arterovenose (MAV) [3][4][5][6][7][8][9][10][11][12][13][14].…”