Z Kardiol 94: Suppl 2 (2005)

Transhepatic approach to permanent pacing and ablation procedures in children with complex heart defects
K. Brockmeier1, N. Sreeram2
1Abt. Kinderkardiologie, Klinikum der Universität zu Köln, Köln, BusinessLogic.Land; 2Abt. Kinderkardiologie, Klinikum der Universität zu Köln, Köln;
In patients with complex congenital venous anomalies, or following complex cardiac surgery, interventional catheterization may be facilitated by the transhepatic approach.

Patients and Methods: Four children (age range 2 months to 10 years) underwent transhepatic interventional catheterization. Indications for the transhepatic procedure included: complex venous anatomy associated with visceral heterotaxy syndrome (n=2), and status after a Fontan operation for single ventricle physiology (n=2). Procedures that were performed included ablation of an accessory pathway (n=2), and permanent dual chamber pacemaker implantation (n=2). Percutaneous puncture of the hepatic vein could be successfully performed using surface anatomic landmarks and without ultrasound guidance. In patients with dextrocardia or visceral situs inversus (n=2), a mirror image approach was used in selecting surface landmarks to guide percutaneous puncture. All desired interventions were successfully performed. At completion of the procedure, introducer sheaths were removed and hemostasis achieved by surface compression. None of the cannulated hepatic veins was occluded with a coil. One patient, a 6 year old girl post-Fontan and transhepatic DDDR pacemaker implantation developed a perihepatic hematoma which was managed conservatively, with spontaneous resolution. All other patients were discharged 24 hours later.

Conclusions: The transhepatic approach facilitates catheter intervention procedures in the setting of complex venous anomalies.