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Cirstoveanu C, Georgescu C, Bizubac M, Heriseanu C, Vasile CM, Margarint I, Filip C. Impact of Bedside Balloon Atrial Septostomy in Neonates with Transposition of the Great Arteries in a Neonatal Intensive Care Unit in Romania. Life (Basel) 2023; 13:life13040997. [PMID: 37109527 PMCID: PMC10145815 DOI: 10.3390/life13040997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Transposition of the great arteries (TGA) is the most common congenital heart disease, accounting for 5-7% of all cardiac anomalies, with a prevalence of 0.2-0.3 per 1000 live births. (2) Aim: Our main objectives were to evaluate the clinical safety of balloon atrial septostomy in neonates and the possible complications. Furthermore, we tried to establish whether the procedure should be performed in all TGA patients with small atrial septal defects, regardless of oxygen saturation, within a center where corrective surgery cannot be performed on an emergency basis due to the lack of a permanent cardiac surgery team for arterial switch surgery. (2) Methods: We conducted an observational, retrospective, single tertiary-care center study between January 2008 and April 2022, which included 92 neonates with TGA transferred to our institution for specialized treatment. (3) Results: The median age at the time of the Rashkind procedure was four days. The rate of immediate complications after balloon atrial septostomy (BAS) was high (34.3%), but most were transient (metabolic acidosis and arterial hypotension-21.8%). Twenty patients with TGA managed in our hospital underwent definitive and corrective surgical intervention (arterial switch operation) at a median age of 13 days. Most patients (82.6%) were term neonates, but 16 were born preterm. (4) Conclusions: Urgent balloon atrial septostomy is often the only solution to restore adequate systemic perfusion. Bedside balloon atrial septostomy is a safe, effective, and initial palliative intervention in neonates with TGA, which can be performed in the neonatal unit.
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Affiliation(s)
- Catalin Cirstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Carmina Georgescu
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Carmen Heriseanu
- Neonatal Intensive Care Unit, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
- Department of Pediatric Cardiology, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Irina Margarint
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiovascular Surgery, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatric Cardiology, M.S. Curie Children's Clinical Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Guarguagli S, Nagarajan VD, Marinelli A, Cazzoli I, Sawhney V, Ezzat V, Ernst S. Transseptal puncture via a superior access as an alternative to the conventional femoral route. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shah K, Patel S, Hanson I, Williamson B, Kutinsky I, Dixon S, Haines DE, Mehta NK. Navigating inferior vena cava filters in invasive cardiology procedures: A systematic review. J Cardiovasc Electrophysiol 2021; 32:1440-1448. [PMID: 33772931 DOI: 10.1111/jce.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transfemoral venous access (TFV) is the cornerstone of minimally invasive cardiac procedures. Although the presence of inferior vena cava filters (IVCFs) was considered a relative contraindication to TFV procedures, small experiences have suggested safety. We conducted a systematic review of the available literature on cardiac procedural success of TFV with IVCF in-situ. METHODS Two independent reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from inception to October 2020 for studies that reported outcomes in patients with IVCFs undergoing TFV for invasive cardiac procedures. We investigated a primary outcome of acute procedural success and reviewed the pooled data for patient demographics, procedural complications, types of IVCF, IVCF dwell time, and procedural specifics. RESULTS Out of the 120 studies initially screened, 8 studies were used in the final analysis with a total of 100 patients who underwent 110 procedures. The most common IVCF was the Greenfield Filter (36%), 60% of patients were males and the mean age was 67.8 years. The overall pooled incidence of acute procedural success was 95.45% (95% confidence interval = 89.54-98.1) with no heterogeneity (I2 = 0%, p = 1) and there were no reported filter-related complications. CONCLUSION This systematic review is the largest study of its kind to demonstrate the safety and feasibility of TFV access in a variety of cardiac procedures in the presence of IVCF.
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Affiliation(s)
- Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Sati Patel
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Brian Williamson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Ilana Kutinsky
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Nishaki Kiran Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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Karnire N, Dash P, Pujary N. Transhepatic venous approach to permanent pacemaker implantation in a patient with no conventional access site. MGM JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mgmj.mgmj_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Soto R, Jimenez A, Garcia F, Saenz LC, Rodriguez DA. Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava. HeartRhythm Case Rep 2018; 5:31-35. [PMID: 30693202 PMCID: PMC6342726 DOI: 10.1016/j.hrcr.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Richard Soto
- Division of Cardiology, Department of Cardiac Electrophysiology, National Cardiovascular Institute INCOR, Lima, Peru
| | - Alejandro Jimenez
- Division of Cardiology, Department of Cardiac Electrophysiology, University of Maryland Medical System, Baltimore, Maryland
| | - Fermin Garcia
- Division of Cardiology, Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luis C Saenz
- International Arrhythmia Center, Cardiology Institute, Fundación Cardioinfantil, University of La Sabana, Bogota, Colombia
| | - Diego A Rodriguez
- International Arrhythmia Center, Cardiology Institute, Fundación Cardioinfantil, University of La Sabana, Bogota, Colombia
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6
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Transhepatic Vascular Access for Implantation of a Watchman Left Atrial Appendage Closure Device. REPORTS 2018. [DOI: 10.3390/reports1020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Conventional access through femoral veins may be limited due to tortuosity and venous occlusion secondary to venous thrombosis or congenital anomalies. Another alternative is subclavian veins, but the difficulty in catheter manipulation and stability makes it less favorable in comparison to the transhepatic access for the delivery of the Watchman device.
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7
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Challenges for bilateral pulmonary artery stenting due to occluded femoral veins. Cardiol Young 2018; 28:341-343. [PMID: 29017621 DOI: 10.1017/s104795111700186x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
When the inferior caval vein is occluded or abnormal, jugular and hepatic veins provide alternative routes for interventions. For pulmonary artery stenting, transhepatic access may give a relatively straighter route than that from the jugular veins. We describe the challenges and strategies during transhepatic bilateral pulmonary artery stenting after arterial switch operation complicated by occluded inferior caval vein and congested hepatic veins.
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Cha MJ, Uhm JS, Kim TH, Choi EK, Joung B, Pak HN, Oh S, Lee MH. Two Cases of Transhepatic Implantation of Cardiac Implantable Electronic Device: All Roads lead to Rome. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Transhepatic implant of a trimmed Melody™ valved stent in tricuspid position in a 1-year-old infant. Catheter Cardiovasc Interv 2016; 89:E84-E89. [DOI: 10.1002/ccd.26672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/22/2016] [Accepted: 07/03/2016] [Indexed: 11/07/2022]
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10
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Al Senaidi K, Al Mesned A, Coe JY. Percutaneous transhepatic stenting of a restrictive atrial septal communication in hypoplastic left heart syndrome. Catheter Cardiovasc Interv 2014; 83:E269-71. [PMID: 24532371 DOI: 10.1002/ccd.25442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/08/2014] [Indexed: 11/08/2022]
Abstract
The postnatal survival of patients with congenital cardiac defects such as hypoplastic left heart syndrome (HLHS) is dependent on the patency of the ductus arteriosus and the presence of an unrestrictive atrial septal defect (ASD). We report a six week old infant with HLHS and tricuspid valve regurgitation with restrictive ASD. Transfemoral balloon atrial septostomy provided temporary relief but further attempts were not possible. A transhepatic venous approach to stent the atrial communication was technically successful. This approach may be the only access for certain infant cardiac catheterization interventions, permitting the use of a large delivery system (≥ 8 Fr).
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Affiliation(s)
- Khalfan Al Senaidi
- Division of Pediatric Cardiology, Sultan Qaboos University, Sultanate of Oman
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Qureshi AM, Prieto LR, Bradley‐Skelton S, Latson LA. Complications related to transhepatic venous access in the catheterization laboratory—A single center 12‐year experience of 124 procedures. Catheter Cardiovasc Interv 2014; 84:94-100. [DOI: 10.1002/ccd.25278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Athar M. Qureshi
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Lourdes R. Prieto
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Sharon Bradley‐Skelton
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Larry A. Latson
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
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12
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Nguyen DT, Gupta R, Kay J, Fagan T, Lowery C, Collins KK, Sauer WH. Percutaneous transhepatic access for catheter ablation of cardiac arrhythmias. Europace 2013; 15:494-500. [PMID: 23385049 DOI: 10.1093/europace/eus315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Femoral venous access may be limited in certain patients undergoing electrophysiology (EP) study and ablation. The purpose of this study is to review a series of patients undergoing percutaneous transhepatic access to allow for ablation of cardiac arrhythmias. METHODS AND RESULTS Six patients with a variety of cardiac arrhythmias and venous abnormalities underwent percutaneous transhepatic access. Under fluoroscopic and ultrasound guidance, a percutaneous needle was advanced into a hepatic vein and exchanged for a vascular sheath over a wire. Electrophysiology study and radiofrequency ablation was then performed. All tachycardias, including atrial tachycardia, atrial flutter, atrioventricular nodal tachycardia, and atrial fibrillation, were ablated. Procedural times ranged from 227 to 418 min. Fluoroscopy times ranged from 32 to 95 min. There were no complications. All six patients have been arrhythmia-free in follow-up (5-49 months, mean 23.1 months). CONCLUSION Percutaneous transhepatic access is safe and feasible in patients with limited venous access who are undergoing EP study and ablation for a range of cardiac arrhythmias.
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Affiliation(s)
- Duy Thai Nguyen
- Electrophysiology, University of Colorado, Anschutz Medical Campus, 12401 E. 17th Avenue, B-132, Aurora, CO 80045, USA.
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Abstract
Transhepatic cardiac catheterization and intervention is used in selected cases in our institution. A retrospective review of transcatheter interventions for the pulmonary artery was conducted. Forty-five transhepatic procedures were performed. Thirteen involved intervention, to rehabilitate the branch pulmonary arteries. The median weight of the patients was 9.9 Kg ± 3.4. The patients' age ranged from eight months to 86 months (median 23 months). The largest sheath used was 7F. All the patients underwent success intervention with no complication related either to the transhepatic approach or the intervention. The branch pulmonary artery diameter increased from 4.5 ± 2.2 mm to 7 ± 3 mm. Most of the procedures were performed under conscious sedation / deep sedation protocol. Hemostasis was achieved in all patients by gradual sheath withdrawal, followed by application of upward pressure on the tract from the subcostal area. In the absence of patent femoral veins the transhepatic approach can be used to perform successful and safe interventions, to rehabilitate the pulmonary artery system. It may offer the additional advantage of using larger sheaths than would be felt appropriate for the femoral veins.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics (Division of Pediatric Cardiology), University of Mississippi Medical Center, Mississippi, USA
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Padhi SS, Bakshi KD, Londhe AP. Balloon atrial septostomy through internal jugular vein in a 45-day-old child with transposition of great arteries. Ann Pediatr Cardiol 2011; 3:77-9. [PMID: 20814481 PMCID: PMC2921523 DOI: 10.4103/0974-2069.64363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Balloon atrial septostomy is a common palliative procedure in D-transposition of great arteries. It is technically easy before 2-3 weeks of age when the septum primum is thin. Femoral vein or umbilical vein, when available, is the common access used for this procedure. In situations when these accesses are not available or in case of inferior vena cava interruption, trans-hepatic access is used. Internal jugular vein (IJV) access is not used as it is difficult to enter the left atrium through this route. We describe a case of successful Balloon atrial septostomy done through IJV in a 45-day-old child with emphasis on the technique, hardware and precautions necessary during the procedure.
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Affiliation(s)
- Sumanta S Padhi
- Department of Pediatric Cardiology, Innova Children's Heart Hospital, Secunderabad, India
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Mortell A, Said H, Doodnath R, Walsh K, Corbally M. Transhepatic central venous catheter for long-term access in paediatric patients. J Pediatr Surg 2008; 43:344-7. [PMID: 18280287 DOI: 10.1016/j.jpedsurg.2007.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 10/09/2007] [Indexed: 11/17/2022]
Abstract
Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Access is frequently lost in this group because of thrombosis, infection, or displacement, and vascular options can quickly be exhausted. The last resort access procedure is generally a direct atrial catheter inserted via a thoracotomy. A viable alternative is the percutaneous transhepatic Broviac catheter (Bard Access Systems, Salt Lake City, UT). We retrospectively reviewed the charts of 5 patients who underwent percutaneous transhepatic Broviac insertion for long-term access over a 4-year period in a single institution. Four of the patients (80%) had a significant cardiac abnormality, with 1 patient requiring long-term parenteral nutrition after complicated necrotizing enterocolitis. All patients had significant caval thrombosis, which precluded them having placement of a standard percutaneous or openly placed central catheter. Of the 5 patients, 2 (40%) died of cardiac-related illnesses. Of the 3 surviving patients, 2 had functioning catheters electively removed because they were no longer required. One catheter was removed at thoracotomy for right atrial perforation because of catheter erosion. Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Transhepatic central venous catheters are a feasible, reliable, and relatively easily placed form of central access in patients with multiple venous thromboses requiring long-term access. This route should be considered in paediatric patients requiring central access in preference to a thoracotomy.
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Affiliation(s)
- Alan Mortell
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
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Pulver A, Cowley C. Transhepatic, Transseptal, Anterograde Balloon Angioplasty for Recurrent Neonatal Coarctation. CONGENIT HEART DIS 2007; 2:438-41. [DOI: 10.1111/j.1747-0803.2007.00139.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Pedra CAC, Neves JR, Pedra SRF, Ferreiro CR, Jatene I, Cortez TM, Jatene M, Souza LCB, Assad R, Fontes VF. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv 2007; 70:731-9. [PMID: 17621660 DOI: 10.1002/ccd.21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. BACKGROUND For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. METHODS Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. RESULTS The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. CONCLUSIONS Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.
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Affiliation(s)
- Carlos A C Pedra
- Pediatric Cardiology Division, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil.
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Ebeid MR. Transhepatic vascular access for diagnostic and interventional procedures: Techniques, outcome, and complications. Catheter Cardiovasc Interv 2006; 69:594-606. [PMID: 17152092 DOI: 10.1002/ccd.21012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Early or multiple cardiac catheterizations may result in occlusion of the femoral veins prohibiting their use. The internal jugular or sub-clavian approach may be an appropriate alternative. However, these approaches may not be suitable in patients with surgical interruption of the superior vena cava. In other patients, they may not allow easy access to certain areas of the heart. The transhepatic approach is an important alternative route for performing cardiac catheterization and interventions. Depending on the planned procedure, it may be the preferred route to perform the cardiac catheterization even in the presence of patent femoral veins. The indications, technical details and potential complications of this approach are discussed.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Emmel M, Sreeram N, Pillekamp F, Boehm W, Brockmeier K. Transhepatic approach for catheter interventions in infants and children with congenital heart disease. Clin Res Cardiol 2006; 95:329-33. [PMID: 16598389 DOI: 10.1007/s00392-006-0382-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 02/21/2006] [Indexed: 11/27/2022]
Abstract
UNLABELLED We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore-Tex membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression. RESULTS Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion. CONCLUSION In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.
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Affiliation(s)
- M Emmel
- Klinik und Poliklinik für Kinderkardiologie, Kerpener Str. 62, 50937, Köln, Germany
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Abstract
The efficacy and safety of ultrasound guidance to obtain transhepatic access for cardiac catheterization were investigated in this study. The transhepatic route for access to perform cardiac catheterization has become an acceptable alternative when conventional routes of access have failed. However, the use of ultrasound to guide transhepatic access has not been reported in the literature. We performed a retrospective chart review. Patient characteristics, indications for catheterization, procedures performed, and complications were recorded. All patients who underwent transhepatic cardiac catheterization at Duke University Medical Center were included in this study. Eight patients underwent 12 catheterizations. The median age was 5.3 years (range, 9 months to 13 years) and median weight 18.7 kg (range, 7.1-44.8 kg). Seven catheterizations were diagnostic and 5 were interventional. There were no complications. Transhepatic access with ultrasound guidance is a safe and effective option for obtaining venous access for cardiac catheterization.
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Affiliation(s)
- T A Johnston
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, University of Washington, Seattle, WA 98115, USA
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21
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Benito Bartolomé F, Sánchez Fernández-Bernal C, Garzón Moll G. [Transhepatic access for radiofrequency ablation in a child]. Rev Esp Cardiol 2003; 56:104-6. [PMID: 12550007 DOI: 10.1016/s0300-8932(03)76828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Radiofrequency catheter ablation is safe and effective in children with refractory supraventricular tachycardia and poor response to pharmacological treatment. This procedure may be difficult or impossible to perform in patients with bilateral obstruction of the femoral venous access. In recent years, the transhepatic approach has been found to be safe in children. We report the case of a 19-month-old boy with permanent junctional reciprocating tachycardia who underwent transhepatic catheterization for radiofrequency ablation.
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Affiliation(s)
- Fernando Benito Bartolomé
- Unidad de Arritmias, Laboratorio de Electrofisiología Clínica Cardíaca, Hospital La Paz, Madrid, Spain.
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Saliba Z, Boudjemline Y, Acar P, Hausse A, Sidi D, Bonhoeffer P. Transhepatic closure of a post-fontan hepatic veins to left atrium fenestration in visceral heterotaxia and dextrocardia. J Interv Cardiol 2002; 15:215-7. [PMID: 12141148 DOI: 10.1111/j.1540-8183.2002.tb01060.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This article reports on the transhepatic closure of post-Fontan hepatic veins to left atrium fenestration in a 13-year-old girl with left atrial isomerism, dextrocardia, azygos continuation to the left superior vena cava, and median liver. The transhepatic route seemed to be the less tortuous access to the fenestration which was previously partially occluded with a CardioSeal device. The hepatic veins were entered at the left abdominal side using fluoroscopic guidance and the fenestration was uneventfully occluded with an Amplatzer septal occluder device.
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Affiliation(s)
- Zakhia Saliba
- Service de Cardiologie Pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres 75743 Paris, France
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23
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Affiliation(s)
- G Hausdorf
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Carl-Neuberg Str. 1, D-30625 Hannover, Germany.
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24
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Affiliation(s)
- R Kaye
- Department of Radiology, Children's Hospital of Pittsburgh, Pennsylvania, USA
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25
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McLeod KA, Houston AB, Richens T, Wilson N. Transhepatic approach for cardiac catheterisation in children: initial experience. Heart 1999; 82:694-6. [PMID: 10573495 PMCID: PMC1729203 DOI: 10.1136/hrt.82.6.694] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIM To assess initial experience of cardiac catheterisation in children by the transhepatic approach where conventional venous access is impossible. PATIENTS AND METHODS Percutaneous transhepatic cardiac catheterisation was performed on six occasions in five children (three male) aged 4 to 36 months (mean 17 months). All children had documented femoral venous occlusion and all but one had occlusion of the superior vena cava. Ultrasound was used in five of the six procedures to help identify a large hepatic vein. A 4 F or 5 F sheath was introduced into the vein using the Seldinger technique. In the fourth patient, hepatic venous access was obtained immediately without the assistance of ultrasound. RESULTS Percutaneous transhepatic catheterisation was successfully performed at all six attempts. Total procedure time ranged from 120 to 200 minutes (mean 138 minutes) and screening time from 14 to 22 minutes (mean 16.8 minutes). A serious complication was encountered in only one patient who had a retroperitoneal bleed after administration of thrombolysis for loss of femoral arterial pulse. CONCLUSIONS The percutaneous transhepatic technique can provide a safe alternative approach for cardiac catheterisation in children with multiple venous occlusion. The procedure can be performed very simply using the Seldinger technique and equipment normally used for conventional venous cannulation for cardiac catheterisation.
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Affiliation(s)
- K A McLeod
- Department of Cardiology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK
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26
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Abstract
The risk of left ventricular perforation is a rare but well-recognized complication of percutaneous double balloon mitral valvuloplasty that usually requires surgical bailout. We describe a case of left ventricular perforation with cardiac tamponade, caused by the propulsion of the balloons during balloon mitral valvotomy on an 86-year-old female with previous thoracotomies that was resolved using percutaneous coil embolization of the perforation. This approach to these types of complications, although unlikely to be of extensive use, will serve to expand the horizon of options in the field of interventions. Cathet. Cardiovasc. Intervent. 48:78-83, 1999.
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Affiliation(s)
- C E Ruiz
- Rush University Children's Hospital Heart Center, Chicago, Illinois 60612-3833, USA
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27
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Abstract
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.
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Affiliation(s)
- D Shim
- Division of Pediatric Cardiology, The Heart Center, Children's Hospital Medical Center, Cincinnati, Ohio.
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28
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30
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Cheatham JP, McCowan TC, Fletcher SE. Percutaneous translumbar cardiac catheterization and central venous line insertion: an alternative approach in children with congenital heart disease. Catheter Cardiovasc Interv 1999; 46:187-92. [PMID: 10348540 DOI: 10.1002/(sici)1522-726x(199902)46:2<187::aid-ccd14>3.0.co;2-s] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children with congenital heart disease present major problems with venous access, eliminating conventional routes for cardiac catheterization. Although the transhepatic approach has recently gained popularity, we describe here an alternative approach using percutaneous translumbar approach for cardiac catheterization and/or in-dwelling central line insertion in three children with congenital heart disease. Diagnostic hemodynamic studies, transcatheter delivery of an intravascular stent for left pulmonary artery (LPA) stenosis, and chronic central venous line insertion were performed using this technique. Disadvantages include interventionalist's unfamiliarity with technique, awkward patient positioning, technically more difficult than transhepatic, and potential injury to kidney and bowel. Advantages include avoidance 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 providing another alternative for not only transvenous, but also transarterial access that may be required for intravascular aortic stent delivery. The interventional radiologist should be utilized as a valuable resource to the cardiologist to help teach and supervise this technique in selected infants and children with limited vascular access.
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Affiliation(s)
- J P Cheatham
- Joint Division of Pediatric Cardiology, University of Nebraska and Creighton University at Children's Hospital, Omaha 68114, USA.
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31
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Book WM, Raviele AA, Vincent RN. Repetitive percutaneous transhepatic access for myocardial biopsy in pediatric cardiac transplant recipients. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 45:167-9. [PMID: 9786397 DOI: 10.1002/(sici)1097-0304(199810)45:2<167::aid-ccd14>3.0.co;2-i] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Repetitive transhepatic access for myocardial biopsy in two pediatric cardiac transplant patients is described. Both have documented occlusion of the traditional percutaneous venous sites. Biopsy via the transhepatic route was performed in one patient 11 times and the second patient five times without any complications. The transhepatic approach can be safely used repetitively in pediatric transplant recipients when traditional venous access is not available.
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Affiliation(s)
- W M Book
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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