title: Transthoracic access for cardiac catheterization.
abstract: Patients who have undergone Fontan palliation for congenital heart disease have limited access to the pulmonary venous atrium. We describe a transthoracic approach to the pulmonary venous atrium for diagnostic and therapeutic cardiac catheterization. A total of 22 patients ranging in age from 14 months to 25 years and weighing 7-68 kg underwent transthoracic catheterization. With the aid of fluoroscopic and angiographic markers, a 20 gauge needle was inserted into the pulmonary venous atrium. A floppy-tipped wire was inserted, and a 4 Fr sheath was placed, upsized as needed. Access to the pulmonary venous atrium was obtained for all patients. Therapeutic procedures were completed for all patients. Transthoracic access to the pulmonary venous atrium in patients who have undergone a Fontan operation is a reliable and rapid mode of access, allowing for complex therapeutic procedures to be performed in the catheterization laboratory, obviating the need for additional open heart surgery.
authors.affiliation: Nemours Cardiac Center, A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware 19899, USA.
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Maher
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Murdison
authors.forename: William I
authors.initials: WI
authors.lastname: Norwood
authors.forename: John D
authors.initials: JD
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011652:Pulmonary Circulation; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011859:Radiography