Transcardiac cerebral angiography in a child

The authors present a case in which transfemoral venous, transcardiac cerebral angiography was performed. In this 5-year-old girl with PHACE syndrome, both transfemoral and transbrachial arterial routes could not be used due to aortic interruption and aneurysmal dilation and small looping of the proximal portion of bilateral subclavian arteries. A 5-F balloon-tipped double-lumen catheter was advanced to the right atrium of the heart from the femoral vein. The catheter was then advanced to the left atrium through the patent foramen ovale and was further advanced to the left ventricle and then to the ascending aorta. The balloon catheter was exchanged for a 4-F catheter. Bilateral common carotid angiography was performed without difficulty. This transcardiac approach is useful in the unusual situation in which both femoral and brachial arterial routes are not available.