Retrograde cardiovascular angiography in infants, using a 3.6 French catheter

Diagnostic retrograde arterial catheterization in infants, and small children has been constrained by the risk of arterial thrombosis and the low flow rate of catheters less than #5 French. We performed retrograde arterial catheterization (percutaneous technique in 21 of 24 patients) on 24 infants and small children (median age 3 months, median weight 4.1 kg), using a 3.6 French performed polyethylene catheter. Systemic heparinization was used. Among the group, we performed 23 aortograms, and 4 selective injections into a bronchial artery; all angiograms were of diagnostic quality. Injection rates ranged from 3 cc/sec to 10 cc/sec (median 5 cc/sec) with a peak developed pressure of 300 PSI to 900 PSI (median 700 PSI). No catheter-related complications were encountered during the study. Four of 24 patients developed a decreased pulse, noted immediately following the catheterization; however, pulses returned to normal within 24 hours, and late blood pressure assessment revealed no abnormalities in the catheterized leg. We now recommend this catheter for infants less than 10 kg when the following angiograms are required: 1. retrograde aortography (truncus arteriosus, pulmonary atresia, aortic stenosis, coarctation, coronary anomalies) 2. selective injections of bronchial arteries 3. retrograde catheterization of surgical shunts.