A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed echocardiographic evaluation revealed possible prosthetic valve thrombosis, which was confirmed by fluoroscopy. She was thrombolysed with low dose infusion of tenecteplase. Post thrombolysis her symptoms improved, valve mobility was restored, and haemoptysis subsided. Left sided prosthetic valve thrombosis presenting predominantly with haemoptysis is very rare.

We describe the successful use of recombinant factor VIIa (rFVIIa) in the control of massive haemoptysis in a 17-year-old patient with a Fontan circulation. The patient was intubated and ventilated in the ICU with deteriorating gas exchange. Conventional methods to control the haemoptysis were ineffective, and rFVIIa was successfully administered as a rescue therapy. rFVIIa is a powerful pro-thrombotic agent, which is only licensed in haemophiliacs with acquired inhibitors to anticoagulation. It has been used off-license in the treatment of massive haemorrhage, although a Cochrane review did not show any significant benefit; however, it may have a role as a rescue therapy where alternatives options have been exhausted after careful risk–benefit analysis.

We report the case of a young woman with continuing haemoptysis, pulmonary atresia, previous shunt surgery, and pulmonary hypertension. She was not suitable for further surgery or for therapeutic embolisation of bronchial vessels. Treatment with tranexamic acid resolved the haemoptysis.

Although clinically silent in the majority of cases, enlarged bronchial arteries or systemic-to-pulmonary collateral arteries may complicate congenital heart disease in infants, causing significant left-to-right shunting with subsequent pulmonary congestion and respiratory compromise. So far, pulmonary haemorrhage, a well-known complication in older patients with cyanotic congenital heart disease, has not been described in infancy. We describe the case of a 6-month-old girl with tetralogy of Fallot and absent pulmonary valve who developed haemoptysis with severe respiratory distress following corrective surgery of the cardiac malformation. High-resolution computed tomography of the thorax followed by selective angiography revealed a systemic-to-pulmonary collateral artery originating from the left internal mammary artery. Pulmonary haemorrhage stopped immediately following coil occlusion of the collateral. A second episode of pulmonary haemorrhage occurred at the age of 9 months during mechanical ventilation for treatment of pneumonia. Repeat angiography revealed two more collateral vessels. Again coil occlusion resulted in prompt resolution of pulmonary haemorrhage. According to our experience, enlarged bronchial arteries or systemic-to-pulmonary collateral arteries should be considered in infants with cyanotic heart disease with unexplained pulmonary congestion or prolonged respiratory problems.

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.

We discuss a patient with recoarctation of the aorta who, 4 weeks after reoperation, presented with fresh haemoptysis and was subsequently found at delayed emergency surgery to have a leaking false aortic aneurysm. The case emphasizes the significance of haemoptysis following repair of recoarctation, the difficulty of reoperation due to abnormalities of the aortic wall, and the value of serial magnetic resonance imaging in demonstrating regions of different signal intensity from haemorrhages of varying age around a leaking false aortic aneurysm.

Unrecognized pseudoaneurysm or rupture of a pulmonary artery is a rare but potentially catastrophic complication of pulmonary arterial catheterization. Herein, we describe a teenage patient with a pulmonary arterial pseudoaneurysm, probably iatrogenic, who presented with haemoptysis following catheterization of the right heart. The pseudoaneurysm was successfully embolized using coils inserted by catheter. Increased awareness of this lesion, its rapid recognition, and prompt therapy are the keys to a successful outcome.