Hemoptysis requiring bronchial artery embolization in pulmonary arterial hypertension

Objectives: Hemoptysis is an uncommon complication in patients with pulmonary arterial hypertension (PAH). Although the mechanism of hemoptysis is unknown, treatment with bronchial artery embolization (BAE) is proposed to be a safe and reliable method of treatment. We report our experience in treating PAH patients presenting with acute hemoptysis that required multiple BAEs. Methods: Three female and one male PAH patients, ages 45 ± 9 years (mean ± standard deviation [SD]) presented with acute hemoptysis. Right ventricular systolic pressure and cardiac index at the time of the first episode of hemoptysis were 85 ± 17 mm Hg and 2.7 ± 0.7 L/min/m, respectively. Two of the four patients had recurrent episodes of hemoptysis, requiring multiple BAEs. All four were on intravenous prostacyclin analogue. None were receiving warfarin or endothelin receptor antagonists at the time of the episode. During each episode of hemoptysis, international normalized ratio (INR) was 1.09 ± 0.11 units, and platelet count was 124,000 ± 47,000 per microliter. Results: Each episode of hemoptysis was acutely terminated with BAE. In the majority of cases, patients had multiple aberrant bronchial arteries embolized, and an average of 2.3 arteries was embolized per session (1-4 embolized arteries). Each BAE was performed utilizing polyvinyl alcohol particles, ranging from 250-500 microns. There were no reported complications of the 14 BAE procedures performed. Conclusion: Although the incidence of hemoptysis is unknown and likely underreported, we report our experience in which recurrent hemoptysis was treated with multiple BAE procedures. This report emphasizes the efficacy and safety of BAE in terminating episodes of recurrent hemoptysis in patients with severe PAH.