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Transhepatic approach for catheter interventions in infants and children with congenital heart disease
M Emmel1, N Sreeram, F Pillekamp
1Klinik und Poliklinik für Kinderkardiologie, Kerpener Str. 62, 50937, Köln, Germany.
Insights
Transhepatic access is a feasible approach for pediatric catheter interventions, including complex cases like congenital heart disease and arrhythmias. This method facilitates various procedures, proving effective in selected young patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transhepatic access is an alternative route for catheter interventions when conventional venous access is challenging.
- Pediatric patients often present complex venous anatomy or anomalies complicating standard access.
- Previous studies have explored transhepatic access, but its application in diverse pediatric interventions requires further elucidation.
Purpose of the Study:
- To evaluate the feasibility and safety of transhepatic access for various catheter interventions in pediatric patients.
- To assess the utility of transhepatic access in cases with systemic venous anomalies, femoral venous occlusion, or post-Fontan complications.
- To determine the effectiveness of transhepatic access for procedures like ablation, septal defect closure, pulmonary artery dilation, and pacemaker implantation.
Main Methods:
- Retrospective review of six pediatric patients (2.5 months to 9 years) undergoing transhepatic catheter interventions.
- Utilized transhepatic access for procedures including accessory pathway ablation, atrial septal defect closure, pulmonary artery balloon dilation, and DDDR pacemaker implantation.
- Employed a mirror image approach in patients with left atrial isomerism.
Main Results:
- Transhepatic access was successfully established in all six pediatric patients.
- Interventional procedures were performed as planned, demonstrating the efficacy of the approach.
- One patient developed a subcutaneous hematoma requiring blood transfusion following pacemaker implantation, indicating a potential complication.
Conclusions:
- Transhepatic access is an easily achievable and effective method for selected pediatric patients requiring complex catheter interventions.
- This approach provides a viable solution for cases with challenging venous anatomy or specific procedural requirements.
- Further research may explore optimizing techniques and minimizing risks associated with transhepatic access in pediatric populations.
Unlabelled:
We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore-Tex membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression.
Results:
Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion.
Conclusion:
In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.
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