TRANSHEPATIC CARDIAC-CATHETERIZATION IN CHILDREN - EVALUATION OF EFFICACY AND SAFETY

Background In some children with congenital heart disease, conventiona l venous access is unavailable for cardiac catheterization. This study investigates a novel transhepatic venous approach to cardiac catheter ization in children and evaluates its efficacy and safety. Methods and Results Percutaneous transhepatic puncture was performed using a 22-g auge Chiba needle under fluoroscopic guidance. After wire exchanges we re performed, a 5F to 8F sheath was positioned in the low right atrium and cardiac catheterization was performed. On completion of the cathe terization, the sheath was withdrawn and a 3-mm steel coil was placed in the parenchymal tract between the hepatic vein and liver capsule. L iver enzyme studies were obtained before and after transhepatic cathet erization, and an abdominal ultrasound was performed to evaluate the l iver 24 hours after the procedure. Percutaneous transhepatic cardiac c atheterization was performed successfully in 17 of 18 children in whom it was attempted. Patient age was 30+/-8 months (mean+/-SEM; range, 1 day to 9 years), weight was 10.5+/-1.5 kg (3.1 to 27.5 kg), and mean right atrial pressure was 10+/-1 mm Hg (5 to 19 mm Hg). Time from init ial needle puncture to right atrial entry was 6.2+/-1.2 minutes. Diagn ostic catheterization was performed successfully in all 17 children, a nd additional interventional procedures were performed in 5 children. The total catheterization time was 2.0+/-0.2 hours. Serum aspartate am inotransferase increased from 57+/-15 to 78+/-8 IU/L (P=.06), but alan ine aminotransferase and gamma-glutamyl transpeptidase did not change. Ultrasound was performed 24 hours after transhepatic catheterization, and no evidence was found in any patient of hemorrhage or subcapsular hematoma. Conclusions These data suggest that this novel transhepatic approach provides an effective and safe route for diagnostic and inte rventional cardiac catheterization in children.