Transhepatic approach for cardiac catheterisation in children: initial experience
K A McLeod, A B Houston, T Richens, N Wilson
Department of
Cardiology, Royal Hospital for Sick Children, Yorkhill, Glasgow
G3 8SJ, UK
Correspondence to: Dr McLeod
Accepted for publication 5 July 1999
AIM
To assess initial
experience of cardiac catheterisation in children by the transhepatic
approach where conventional venous access is impossible.
PATIENTS AND
METHODSPercutaneous transhepatic cardiac
catheterisation was performed on six occasions in five children (three
male) aged 4 to 36 months (mean 17 months). All children had documented
femoral venous occlusion and all but one had occlusion of the superior
vena cava. Ultrasound was used in five of the six procedures to help
identify a large hepatic vein. A 4 F or 5 F sheath was introduced into the vein using the Seldinger technique. In the fourth patient, hepatic
venous access was obtained immediately without the assistance of ultrasound.
RESULTSPercutaneous
transhepatic catheterisation was successfully performed at all six
attempts. Total procedure time ranged from 120 to 200 minutes (mean 138 minutes) and screening time from 14 to 22 minutes (mean 16.8 minutes).
A serious complication was encountered in only one patient who had a
retroperitoneal bleed after administration of thrombolysis for loss of
femoral arterial pulse.
CONCLUSIONSThe
percutaneous transhepatic technique can provide a safe alternative
approach for cardiac catheterisation in children with multiple
venous occlusion. The procedure can be performed very simply using the
Seldinger technique and equipment normally used for conventional venous
cannulation for cardiac catheterisation.
Keywords: cardiac catheterisation; transhepatic approach; congenital heart defects
© 1999 by Heart
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