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Published on: July 18, 2014
Right-heart catheterization using antecubital venous access in patients with complex congenital heart defects and
Sezen Atik Ugan1, Selman Gökalp1, Betül Çınar1
1Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.
Insights
The antecubital venous approach is a safe and effective technique for right-heart catheterization in children with congenital heart defects, particularly those with a Glenn anastomosis. This method should be considered the primary access site for pediatric cardiac catheterization.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Right-heart catheterization (RHC) via antecubital veins is gaining traction in adults.
- Pediatric RHC commonly uses other venous access sites, despite adult evidence.
- Complex congenital heart defects (CCHD) and Glenn anastomosis present unique challenges for venous access.
Purpose of the Study:
- To describe the technique and outcomes of antecubital venous approach for RHC in pediatric patients with CCHD.
- To evaluate the safety and feasibility of this approach in a complex pediatric population.
- To advocate for the antecubital venous approach as a preferred access site in specific pediatric cases.
Main Methods:
- Retrospective review of 18 pediatric patients undergoing RHC via antecubital veins (January 2014 - August 2017).
- Inclusion criteria: various clinical indications, including CCHD and Glenn anastomosis.
- Procedures included diagnostic catheterization and interventional procedures.
Main Results:
- 10 male, 8 female patients; 17 had CCHD with Glenn anastomosis.
- One patient had complex anatomy with superior vena cava occlusion.
- Diagnostic and interventional procedures (e.g., balloon occlusion, anastomosis dilatation, collateral occlusion) were successfully performed.
Conclusions:
- The antecubital venous approach is safe and feasible for diagnostic and therapeutic RHC in pediatric patients with CCHD.
- This technique is particularly suitable for patients with a Glenn anastomosis.
- The authors recommend the antecubital venous approach as the primary choice for RHC in this population.
Objective:
Right-heart catheterization using the antecubital veins has recently regained attention, and studies demonstrating the feasibility and safety of antecubital access in adults have been published. However, no changes have been observed in the preferred entrance sites in right-heart catheterizations in children with congenital heart diseases. This article is a description of the technique and features of the antecubital venous approach in pediatric patients with complex congenital heart defects and a Glenn anastomosis.
Methods:
The data regarding a right cardiac catheterization through the antecubital fossa veins performed in 18 patients with various clinical indications between January 2014 and August 2017 were reviewed retrospectively and the results were assessed.
Results:
Ten patients (55%) were male and 8 patients were female. All of the patients but 1 had a complex congenital heart disease with a Glenn anastomosis. One patient had been operated on for a sinus venosus atrial septal defect and an abnormal pulmonary venous return and had a total occlusion of the superior vena cava. A diagnostic catheterization was performed in all cases. Additional procedures consisted of a balloon test occlusion of the pulmonary valve in 2 patients, a superior vena cava-right pulmonary artery anastomosis dilatation in 1, and abnormal veno-venous collateral occlusion with various devices in 2 patients.
Conclusion:
The antecubital venous approach technique can be performed easily and safely for diagnostic and therapeutic catheterization in patients with complex congenital heart defects. The authors advocate that the antecubital venous approach should be the first site selected for right-heart catheterization, especially in patients with a Glenn anastomosis.
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