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Children with complex congenital heart disease often have difficult central venous access as a result of prior procedures. In addition, there may a need to preserve their central veins for future cardiac catheterizations or surgeries. In many of these patients (pts.), transhepatic venous access is a vital modality for cardiac catheterizations and central venous access, however significant complications can occur.
The records of pts. who underwent transhepatic venous access between 6/2000- 10/2012 at The Center for Pediatric and Congenital Heart Disease at The Cleveland Clinic were reviewed. IRB approval was obtained for the study. Transhepatic access was obtained using biplane fluoroscopy in the majority of pts. and ultrasound in 2 pts.
124 transhepatic procedures were performed in 81 pts. during the study period. The diagnoses included single ventricle circulations in 50, pulmonary atresia/VSD in 10, cardiomyopathy in 3, heart transplant in 2 and other complex biventricular circulations in 16 pts. The median weight of the pts.was 6.3 (2.2–94) kg. with a median age of 7 months (2 weeks-35 years). Diagnostic catheterizations were performed in 75, interventions in 39 and central venous line placement in 91 procedures (tunneled catheters n=80, non-tunneled catheters n=11). The median maximum sheath size inserted was 8 (4-14) French. There were 12 (10%) major complications (complete heart block requiring intervention n=6; bleeding requiring intervention and transfusion n=6, with 1 death as a result). Heart block persisted in 3 pts. (2 paced for 2 weeks and 1 month; and 1 with recovery 2 days later). Factors such as weight, age and maximum French size of sheath were not associated with complications. Diagnostic and interventional procedures were not associated with more complications compared with procedures involving central venous line placement alone (p= 0.7). There were 24 late deaths unrelated to the transhepatic prodedures.
Transhepatic access is an extremely vital modality of access to the heart and vascular structures in children with complex heart disease. Prevention of complications should focus on minimizing bleeding risks and heart block.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Congenital Catheter Interventions
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1291-123
- 2013 American College of Cardiology Foundation