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Transhepatic approach for cardiac catheterisation in children: initial experience
K A McLeod1, A B Houston, T Richens
1Department of Cardiology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK.
Insights
The transhepatic approach offers a safe alternative for pediatric cardiac catheterization when conventional venous access is blocked. This technique, using the Seldinger technique, is effective for children with venous occlusions.
Area of Science:
- Pediatric Cardiology
- Interventional Radiology
- Vascular Access
Background:
- Conventional venous access for cardiac catheterization in children can be challenging.
- Venous occlusion, particularly of the femoral vein and superior vena cava, necessitates alternative approaches.
Purpose of the Study:
- To evaluate the initial experience and feasibility of the transhepatic approach for pediatric cardiac catheterization.
- To assess the safety and efficacy of this technique when standard venous access is impossible.
Main Methods:
- Percutaneous transhepatic cardiac catheterization was performed in six instances on five pediatric patients (4-36 months).
- Ultrasound guidance was utilized in most cases to identify hepatic veins for sheath insertion via the Seldinger technique.
- Patients had documented femoral venous occlusion, and most also had superior vena cava occlusion.
Main Results:
- The transhepatic approach was successful in all six procedures.
- Procedure times averaged 138 minutes, with screening times averaging 16.8 minutes.
- A single serious complication (retroperitoneal bleed) occurred in one patient.
Conclusions:
- The percutaneous transhepatic technique is a safe and viable alternative for pediatric cardiac catheterization in cases of multiple venous occlusions.
- The procedure is straightforward, utilizing standard Seldinger technique and equipment.
Aim:
To assess initial experience of cardiac catheterisation in children by the transhepatic approach where conventional venous access is impossible.
Patients And Methods:
Percutaneous 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.
Results:
Percutaneous 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.
Conclusions:
The 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.
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