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Curso de Atualização em Medicina Cardiovascular 2019
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Use of microspheres for embolization of bronchial arteries in an 11-year-old child with haemoptysis
Session:
Sessão de Casos Clínicos - II
Speaker:
Guilherme Lourenço
Congress:
CPC 2019
Topic:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Guilherme Lourenço; José Diogo Ferreira Martins; Petra Loureiro; Maria De Fátima Pinto
Abstract
<p>Introduction: Cystic fibrosis associated with bronchiectasis is the most common cause of haemoptysis in children in developed nations. Paediatric Cardiology centres have experience in catheterization of bronchial and aortopulmonary collateral arteries. Bronchial artery embolization is an effective therapy in adults, and rarely in children.</p> <p>Clinical Case: 11-year-old female, with cystic fibrosis and bronchiectasis, was admitted due to recurring episodes of haemoptysis in moderate quantity, in the left lower lobe. After failure of medical therapy, she was transferred to our centre for attempted percutaneous occlusion of the bleeding vessel. The aortography identified a proximal bronchial artery that bifurcates into a right and left branch, and a distal bronchial artery that only perfuses the right lung. The ostium of the proximal bronchial artery was catheterized with a JR 2.5 catheter, and a 0.14 Whisper® guidewire was placed distally in the left branch. A Finecross® microcatheter was placed over the guidewire. We selectively embolized the vessel with 500µm Embozene® microspheres with a higher 1:2 contrast dilution. Post-occlusion angiography confirmed complete and selective occlusion of the left lower lobe bronchial artery branch. There were no complications. The patient was discharged shortly after the procedure. With 1-month follow-up, there are no recurrences of haemoptysis.</p> <p>Conclusion: Microsphere embolization was effective in treating this patient with no complications. The use of a microcatheter allowed for selective catheterization of the bleeding vessel. The use a 1:2 microsphere mix was effective, without the occurrence of catheter obstruction.</p>
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