Percutaneous translumbar cardiac catheterization and central venous line insertion: An alternative approach in children with congenital heart disease

Children with congenital heart disease present major problems with venous a ccess, eliminating conventional routes for cardiac catheterization. Althoug h the transhepatic approach has recently gained popularity, we describe her e an alternative approach using percutaneous translumbar approach for cardi ac catheterization and/or in-dwelling central line insertion in three child ren with congenital heart disease. Diagnostic hemodynamic studies, transcat heter delivery of an intravascular stent for left pulmonary artery (LPA) st enosis, and chronic central Venous line insertion were performed using this technique. Disadvantages include interventionalist's unfamiliarity with te chnique, awkward patient positioning, technically more difficult than trans hepatic, and potential injury to kidney and bower. Advantages include avoid ance of vascular-rich hepatic parenchyma, thus reducing risk of hemorrhage; providing an alternative where transhepatic entry may be contraindicated; avoidance of bile duct, portal vein, and hepatic artery injury; and providi ng another alternative for not only transvenous, but also transarterial acc ess that may be required for intravascular aortic stent delivery. The inter ventional radiologist should be utilized as a valuable resource to the card iologist to help teach and supervise this technique in selected infants and children with limited vascular access. (C) 1999 Wiley-Liss, Inc.