INTRODUCTION
Adults with congenital heart disease represent an expanding patient population requiring life-long tertiary medical care. Approximately 5% to 10% of them develop pulmonary arterial hypertension (PAH) of variable severity [1]. In the anomalous origin of the pulmonary artery, the pathological branch originates from the ascending aorta, with an incidence of about 0.12% [2], hence often being a misdiagnosis or a missed diagnosis. Left-to-right shunting caused by patent ductus arteriosus is more pronounced in the presence of an additional shunt-like anomalous origin of the pulmonary artery (AOPA). AOPA coupled with PDA could present with lethal complications like hemoptysis in the clinical course of disabling pulmonary hypertension [3]. The incidence of hemoptysis is estimated at 3.1% to 5.5% [4] in PAH-congenital heart disease (CHD) patients and is thus a rare clinical picture. Follow-up is key for these patients to promptly detect new or misdiagnosed pathologic findings [3]. CHD-PAH patients have been found to have a survival advantage compared to those with other types of PAH presenting with hemoptysis and hence require prompt recognition and multi-centered treatment strategies [5]. Numerous strategies employed in the past include supportive care, surgical resection, and lung transplants. Presently, the most commonly used strategy is bronchial artery embolization (BAE) [5]. BAE is minimally invasive and has proved to be an immense success, resulting in rapid cessation of hemoptysis with low complication rates [4]. Recent studies have shown the effectiveness of tranexamic acid in reducing the volume and duration of hemoptysis [6]. Despite milestone advances in PAH-targeted treatment strategies and techniques, the morbidity burden of hemoptysis remains high, causing impaired quality of life with a global impact on healthcare systems, hence requiring a case-specific approach and close interdisciplinary management. This includes collaboration among adult CHD experts, pulmonologists, radiologists, and thoracic surgeons in tertiary centers [3, 4].