Open Access

ARTICLE

Standardized Management of Acute Pulmonary Hemorrhage after Percutaneous Pulmonary Vein Intervention

Catalina Vargas-Acevedo¹, Gareth J. Morgan¹, Rhynn Soderstrom², Richard Ing³, Nicholas Houska³, Jenny E. Zablah^1,*
1 Department of Pediatric Cardiology, University of Colorado, The Heart Institute, Children’s Hospital Colorado, Aurora, CO 80045, USA
2 Department of Pharmacology, Children’s Hospital Colorado, Aurora, CO 80045, USA
3 Department of Anesthesia, University of Colorado, Children’s Hospital Colorado, Aurora, CO 80045, USA
* Corresponding Author: Jenny E. Zablah. Email:

Congenital Heart Disease https://doi.org/10.32604/chd.2024.055121

Received 18 June 2024; Accepted 09 September 2024; Published online 27 September 2024

Abstract

Introduction: Pulmonary hemorrhage (PHm) is a life-threatening complication that can occur after catheter-based interventions in patients with pulmonary vein stenosis (PVS). Inhaled racemic epinephrine (iRE) and tranexamic acid (iTXA) have been used in other conditions, but a standardized approach in PVS has not been described. We aimed to describe the current management of PHm after PVS catheter-based interventions. Methods: We present a retrospective review of episodes of PHm from July 2022 to February 2024. PHm was defined as frank blood suctioned from the endotracheal tube including blood-tinged secretions and >3% decrease in saturations and/or ventilatory changes with or without acute chest X-ray changes. Each individual episode of PHm was considered a separate event. Incidence was calculated based on the total number of PVS interventions during the study period. Results: Eleven episodes of PHm were identified out of 108 PVS interventions, resulting in an incidence of 10.2%. Five (45.5%) had primary PVS, and seven (63.6%) had bilateral PVS. The median age at PHm was 23 months (3–91 months). Four episodes were treated with iRE, five with both iRE and iTXA, and two with only iTXA due to a history of suprasystemic right ventricular pressures. Median time on mechanical ventilation after PHm was 24 h (15–72 h) and a median ICU stay of 2 days (1–8 days). Hemostasis was achieved in all events. There were no adverse events after iTXA, however, transient hypertension was observed after iRE which was dose-related. Conclusions: The implementation of a standardized protocol for the treatment of PHm in PVS has the potential to improve procedural planning, has a wider availability of medications, and greater awareness by the providers involved, possibly leading to earlier detection of PHm and appropriate treatment.

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Keywords

Pulmonary vein stenosis; congenital heart disease; pulmonary hemorrhage; inhaled tranexamic acid; racemic epinephrine

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