JPGN Reports · 4 authors, 3 centres
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This case report describes two children with complex congenital heart disease and pulmonary venous obstruction who developed rare cardiac-derived esophageal variceal hemorrhage, not related to liver disease. The central result is that endoscopic variceal ligation in one patient was followed by pulmonary hemorrhage, suggesting that ablating these collateral varices may carry significant risks.
The report presents two pediatric cases of cardiac-derived esophageal variceal hemorrhage secondary to congenital heart disease with long-term pulmonary venous obstruction. Both patients had no evidence of liver disease or portal hypertension. In Case 1, endoscopic variceal ligation for active bleeding was complicated by acute pulmonary hemorrhage, while Case 2, managed without intervention, had no recurrence. The authors highlight that established guidelines for varices in liver disease are not applicable here. They propose that endoscopic ligation for cardiac-derived varices should be reserved for acute, medically refractory bleeding, as obliterating these decompressing collaterals may worsen pulmonary hypertension and cause pulmonary hemorrhage.
