Percutaneous heart catheterization in infants and children. I. Catheter placement and manipulation with guide wires

Venous Thrombosis after Cardiac Catheterization in Infants

Factors influencing the rate of post-catheterization venous thrombosis were studied in 180 infants below one year of age. The initial cardiac catheterization was performed either with ***cut-down technique or percutaneously. At repeat catheterization on the ipsilateral side presence or absence of thrombosis was noted. The overall thrombosis frequency was higher than previously reported, 15.6 per cent. The rate increased with decreasing weight. An increased rate of thrombosis was also found with indwelling femoral vein catheter left in place for more than 24 hours, and infection. In 6 cases, thrombosis involved only the catheterized side and would have been missed by recatheterization from the contralateral side. It was noteworthy that 9 of the thromboses spared the catheterized vessel and engaged only the vena cava. Among factors not influencing thrombosis rate were age, type of cardiac malformation, cyanosis, early operation, catheterization time or balloon septostomy. Percutaneous or ***cut-down technique did not influence thrombosis rate.

Retrograde cardiovascular angiography in infants, using a 3.6 French catheter

Diagnostic retrograde arterial catheterization in infants, and small children has been constrained by the risk of arterial thrombosis and the low flow rate of catheters less than #5 French. We performed retrograde arterial catheterization (percutaneous technique in 21 of 24 patients) on 24 infants and small children (median age 3 months, median weight 4.1 kg), using a 3.6 French performed polyethylene catheter. Systemic heparinization was used. Among the group, we performed 23 aortograms, and 4 selective injections into a bronchial artery; all angiograms were of diagnostic quality. Injection rates ranged from 3 cc/sec to 10 cc/sec (median 5 cc/sec) with a peak developed pressure of 300 PSI to 900 PSI (median 700 PSI). No catheter-related complications were encountered during the study. Four of 24 patients developed a decreased pulse, noted immediately following the catheterization; however, pulses returned to normal within 24 hours, and late blood pressure assessment revealed no abnormalities in the catheterized leg. We now recommend this catheter for infants less than 10 kg when the following angiograms are required: 1. retrograde aortography (truncus arteriosus, pulmonary atresia, aortic stenosis, coarctation, coronary anomalies) 2. selective injections of bronchial arteries 3. retrograde catheterization of surgical shunts.

Right heart pigtail catheter for selective angiocardiography

The use of a modified pigtail catheter for right heart angiocardiography provides a safe method of obtaining good quality contrast studies of right heart lesions in infants and children. The catheter is also useful in left ventriculography in complete atrioventricular canals or other complex cardiac lesions.

A new technique for noninvasive evaluation of femoral arterial and venous anatomy before and after percutaneous cardiac catheterization in children and infants

A new ultrasonic method was applied to image the femoral artery and vein in children for evaluation of short- and long-term effects of cardiac catheterization with femoral percutaneous cannulation. Sixty-six children and infants (aged 5 days to 20 years) were studied with a 9 megahertz electronically focused real time scanner. Adequate studies were obtained in 46 patients before catheterization, in 26 of 30 short-term follow-up studies and in 14 long-term follow-up studies. Femoral arterial size could be quantitatively measured at the inguinal ligament and a correlation existed between imaged femoral arterial diameter and body weight (r = +0.82) or body surface area (r = +0.80). Short-term follow-up ultrasonic imaging studies allowed diagnosis of spasm and other complications of percutaneous femoral arterial puncture. Long-term follow-up studies were performed 4 months to 3 years after catheterization in 14 patients who had no complications recorded at the time of catheterization. These revealed significant differences between vessels on the catheterized and uncatheterized (control) sides in only 3 of the 14. High resolution ultrasonic imaging can provide anatomic and functional information about femoral arteries and veins and appears to be of assistance in planning cardiac catheterization and in studying the short- and long-term effects of percutaneous femoral cannulation.

Heparinization for prevention of thrombosis following pediatric percutaneous arterial catheterization

One thousand three hundred and sixteen consecutively catheterized infants and children were evaluated prospectively for femoral artery thrombosis following percutaneous cardiac catheterization. One hundred units/kg heparin bolus was given to 649 patients after arterial puncture (group A). A supplementary 50 units/kg of heparin bolus was given to 381 patients 75 minutes later, followed by a continuous heparin infusion if pulses were decreased (group B). Two hundred forty-one patients were managed similarly except the first supplementary bolus was given 45 minutes after initial heparinization, if necessary, and the second bolus and continuous infusion were begun 45 minutes later, if necessary (group C). Arterial thrombosis was diagnosed if pulses were not equal to those of the unused extremity 6 hours following catheterization. The overall incidence of arterial thrombosis was 0.8%. No statistically significant (p less than .05) differences occurred related to the heparinization method used. However, absence of thrombosis in the last 241 consecutive patients (group C) and in the last 480 patients of groups B and C weighing more than 10 kg approaches significance (p less than .1). Incidence of thrombosis was less than in previous studies (p less than .0005 to .05). This study indicates that a very low incidence of arterial thrombosis can be achieved with systemic heparinization.

A new technique in advancing the catheter from the left atrium to the left ventricle

A technique is described by which a catheter is advanced from the left atrium to the left ventricle during a right heart catheterization via the leg. A loop in the catheter is created by the clockwise twisting of the catheter while it is gently pushed against the posterior left wall of the left atrium. The catheter is then pulled back and is twisted counter-clockwise. The catheter has to be soft, and biplane fluroscopy is required. During a 16-month period 162 consecutive infants and children had heart catheterization performed, during which a pediatric NIH catheter was passed to the left atrium. The loop-technique was attempted in 95 patients and was successful in 66 patients. One or two attempts were usually in 95 patients and was successful in 66 patients. One or two attempts were usually sufficient. No complications were encountered apart from two brief episodes of bradycardia. The technique is easy to perform with a reasonable success rate. It seems most useful in infants in whom 5F catheters are used.

Cardiac catheterization by percutaneous femoral venous approach in infants weighing less than 5 kg: observations in 97 cases

The technique of cardiac catheterization after percutaneous introduction of a catheter can now be accomplished in neonates thanks to the refinement of the equipment and to the physicians' experience. In 100 catheterizations performed in infants of less than 5 kg, the new technique was utilized 97 times. Thanks to the utilization of introducers it permits Rashkind atrioseptostomy. Its main advantage is the preservation of venous integrity and this allows repeat investigations through the same route.

Advances in invasive cardiac diagnosis and management

Cardiac catheterization is now a relatively safe procedure when performed by an experienced pediatric cardiology team in a medical center with full ancillary pediatric services as well as cardiac surgery available on a 24 hour basis. Advances in equipment and techniques such as improved radiological equipment, newer catheters, and angled angiocardiographic views have improved diagnostic studies such that intraoperative changes in the preoperative diagnoses fortunately are rare. The use of prostaglandin E1 in neonates with either pulmonary atresia or the coarctation syndrome to achieve ductal dilatation with resultant marked clinical improvement preoperatively is a major advance that should become a standard method of therapy over the next few years. Newer catheterization techniques include devices for enlarging atrial septal defects (balloons and blades), closing atrial septal defects, closing a patent ductus, and performing myocardial biopsies in infants. All of these latter techniques hold promise for extending the pediatric cardiologist's role in providing newer diagnostic as well as therapeutic techniques in the care of infants and children with heart disease.

Transvascular endomyocardial biopsy in infants and small children: description of a new technique

A miniaturized technique for transcatheter endomyocardial biopsy has been developed in the belief that myocardial biopsy performed in infancy, when the disease process in cardiomyopathy may be most active, should yield important etiologic and nosologic information. To obtain six biopsy specimens, three from each ventricle, adds about 1 hour to a diagnostic right and left heart catheterization. A no. 4 or 5 French forceps with a modified soft shaft is guided to the site in theapical septum of the right and left ventricles through a previously molded to measure guide tube of ultrathin radiopaque Teflon. With biplane fluoroscopy the guide tube of ultrathin radiopaque Telflon. With biplane fluorsocopy the guide tube is introduced as a sheath over a matching catheter and the catheter is removed. Contrast medium in injected to verify position, the forceps is introduced and the biopsy specimen is taken. If the forceps is sharp and pressure on the endocardium in light, evidence of biopsy is not discrenible on examination of the heart 1 week later. The method was developed in small dogs and proved safe and effective in rabbits weighing 3 kg. Biopsy has been performed safely in children aged 4 1/2 months to 5 1/2 years and weighing 4.5 to to 19.6 kg.

Percutaneous cardiac catheterization and atrial balloon septostomy in pediatrics

Between November, 1971, and July, 1975, 688 patients ranging in age from six hours to 21 years have undergone percutaneous transfemoral venous and/or arterial catheterization at the University of Oregon Health Sciences Center. This represents 93% of all venous catheterizations of the right side of the heart and 97% of all arterial catheterizations of the left side of the heart in the pediatric age range. One hundred and ninety-five patients (29% of the group) weighed 5 kg or less and 133 (20% of the group) were neonates. There were virtually no complications following the venous studies. The complication rate following percutaneous arterial studies is lower than is the reported experience with cut-down arteriotomies. Long-term survival following percutaneous atrial balloon septostomy in D-transposition of the great arteries was comparable to that following cut-down balloon septostomy. The ease of accomplishment, significantly lower complication rate, and successful accomplishment of atrial balloon septostomy prompt us to advocate that the percutaneous technique of cardiac catheterization be extended to include the neonate and young infant who weighsless than 5 kg.

Case report: simple renal cyst in child

A case of a large renal cyst of the right kidney suggesting a nephroblastoma is reported. Preoperative differentiation was diffucult.