{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:25:06Z","timestamp":1787837106232,"version":"build-2784847793"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:p>Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon.<\/jats:p>","DOI":"10.4103\/aca.aca_137_17","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T06:37:25Z","timestamp":1716878245000},"page":"78-81","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Bleeding in the Lung Complicates a Routine Intracardiac Repair: What Went Wrong!!!"],"prefix":"10.4103","volume":"21","author":[{"given":"Neeti","family":"Makhija","sequence":"first","affiliation":[{"name":"Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Magoon","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minati","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivasubramanian","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250602","first-page":"656","article-title":"Coagulation in cyanotic congenital heart disease","volume":"124","author":"Wedemeyer","year":"1972","journal-title":"Am J Dis Child"},{"key":"R2-20250602","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1136\/hrt.41.1.23","article-title":"Haemostatic defects in cyanotic congenital heart disease","volume":"41","author":"Henriksson","year":"1979","journal-title":"Br Heart J"},{"key":"R3-20250602","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1016\/S0003-4975(01)02475-4","article-title":"Tetralogy of Fallot: Surgical management individualized to the patient","volume":"71","author":"Fraser","year":"2001","journal-title":"Ann Thorac Surg"},{"key":"R4-20250602","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/S0022-5223(95)70076-5","article-title":"The management of tetralogy of Fallot with pulmonary atresia and diminutive pulmonary arteries","volume":"110","author":"Pagani","year":"1995","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R5-20250602","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S1010-7940(99)00138-4","article-title":"Median sternotomy single stage complete unifocalization for pulmonary atresia, major aorto-pulmonary collateral arteries and VSD-early experience","volume":"16","author":"Murthy","year":"1999","journal-title":"Eur J Cardiothorac Surg"},{"key":"R6-20250602","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/S1010-7940(01)00855-7","article-title":"Pulmonary atresia with ventricular septal defect, extremely hypoplastic pulmonary arteries, major aorto-pulmonary collaterals","volume":"20","author":"Metras","year":"2001","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00660469-201821010-00020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:16:17Z","timestamp":1787836577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00660469-201821010-00020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":6,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_137_17","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1]]}}}