Transhepatic therapeutic cardiac catheterization: a new option for the pediatric interventionalist.
We evaluate the efficacy and safety of percutaneous transhepatic (TH) venous access for interventional cardiac catheterization. A retrospective review of all TH therapeutic catheterizations between January 1994 and September 1998 was performed. Patient demographics, pre- and postcatheterization hemoglobin and liver function studies, and complications were evaluated. TH access was performed for 30 interventional catheterizations in 25 patients with a median age of 39 months (range, 1 day to 41 years) and weight of 13.2 kg (3.1-87.0 kg). Indications for TH access were bilateral obstructed femoral veins (n = 15), obstructed femoral veins and superior vena cava (n = 3), Greenfield filter (n = 2), and presumptive improved route for intervention via TH access (n = 5). TH interventions were successful in 29/30 procedures (97%). Interventions via TH sheath sizes of 4-14 Fr included pulmonary angioplasty +/- stent (n = 11), radiofrequency ablation (n = 4), atrial septal defect device occlusion (n = 2), coil occlusion of pulmonary artery pseduoaneurysm (n = 2), Fontan fenestration device occlusion (n = 2), pulmonary valvuloplasty (n = 2), stent dilation of the superior vena cava (n = 2), and one each of device retrieval, Fontan baffle stent placement and subsequent redilation, Fontan fenestration dilation, transseptal mitral valvuloplasty, and cardiac biopsy. There were no changes in pre- and post-TH hemoglobin levels (mean +/- SD, 12.9+/-2.2 vs. 11.9+/-1.9 gm/dL; P = NS) or alanine transferase (34.0+/-27.5 vs. 43.4+/-18.2 IU/L; P = NS). One patient developed important intraperitoneal bleeding and required exploratory laporatomy. Percutaneous TH access is safe and effective as a route for interventional catheter procedures for patients with limited venous access.
Shim
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Division of Pediatric Cardiology, The Heart Center, Children's Hospital Medical Center, Cincinnati, Ohio. dshim@chmcc.org
Lloyd
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Beekman
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D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002932:Cineangiography; D004621:Embolization, Therapeutic; D005069:Evaluation Studies as Topic; D006331:Heart Diseases / Q000628:therapy*; D006503:Hepatic Veins; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents