TRANSHEPATIC CARDIAC-CATHETERIZATION IN CHILDREN - EVALUATION OF EFFICACY AND SAFETY
TRANSHEPATIC CARDIAC-CATHETERIZATION IN CHILDREN - EVALUATION OF EFFICACY AND SAFETY
复制标题
DOI：
10.1161/01.cir.92.6.1526
复制
发表时间：
1995-09-15
期刊：
影响因子：
37.8
通讯作者：
BEEKMAN, RH
中科院分区：
文献类型：
--
作者：
SHIM, D;LLOYD, TR;BEEKMAN, RH
背景 对于一些患有先天性心脏病的儿童，传统的静脉通路无法进行心导管插入术。本研究探讨了一种新型的儿童心导管插入术的肝静脉入路，并评估其有效性和安全性。方法和结果在透视引导下使用 22 号 Chiba 针进行经皮肝穿刺穿刺。进行导线交换后，将 5F 至 8F 鞘管放置在下右心房并进行心导管插入术。导管插入完成后，撤回鞘管，并将3毫米钢圈置于肝静脉和肝包膜之间的实质束中。在肝导管插入术前后进行肝酶研究，并在手术后 24 小时进行腹部超声评估肝脏。 18 名儿童中，有 17 名儿童成功进行了经皮肝穿刺心导管插入术。患者年龄为 30+/-8 个月（平均值+/-SEM；范围，1 天至 9 岁），体重为 10.5+/-1.5 kg（3.1 至 27.5 kg），平均右心房压力为 10+/-1 mm Hg（5 至 19 mm Hg）。从最初的针刺到进入右心房的时间为 6.2+/-1.2 分钟。所有 17 名儿童均成功进行了诊断性导管插入术，并对 5 名儿童进行了额外的介入手术。总导管插入时间为2.0+/-0.2小时。血清天冬氨酸转氨酶从 57+/-15 增加至 78+/-8 IU/L (P=.06)，但丙氨酸转氨酶和 γ-谷氨酰转肽酶没有变化。肝导管术后24小时进行超声检查，未发现任何患者有出血或包膜下血肿的证据。结论这些数据表明，这种新颖的肝导管方法为儿童诊断和介入心导管检查提供了有效且安全的途径。
Background In some children with congenital heart disease, conventional venous access is unavailable for cardiac catheterization. This study investigates a novel transhepatic venous approach to cardiac catheterization in children and evaluates its efficacy and safety.Methods and Results Percutaneous transhepatic puncture was performed using a 22-gauge Chiba needle under fluoroscopic guidance. After wire exchanges were performed, a 5F to 8F sheath was positioned in the low right atrium and cardiac catheterization was performed. On completion of the catheterization, the sheath was withdrawn and a 3-mm steel coil was placed in the parenchymal tract between the hepatic vein and liver capsule. Liver enzyme studies were obtained before and after transhepatic catheterization, and an abdominal ultrasound was performed to evaluate the liver 24 hours after the procedure. Percutaneous transhepatic cardiac catheterization was performed successfully in 17 of 18 children in whom it was attempted. Patient age was 30+/-8 months (mean+/-SEM; range, 1 day to 9 years), weight was 10.5+/-1.5 kg (3.1 to 27.5 kg), and mean right atrial pressure was 10+/-1 mm Hg (5 to 19 mm Hg). Time from initial needle puncture to right atrial entry was 6.2+/-1.2 minutes. Diagnostic catheterization was performed successfully in all 17 children, and additional interventional procedures were performed in 5 children. The total catheterization time was 2.0+/-0.2 hours. Serum aspartate aminotransferase increased from 57+/-15 to 78+/-8 IU/L (P=.06), but alanine aminotransferase and gamma-glutamyl transpeptidase did not change. Ultrasound was performed 24 hours after transhepatic catheterization, and no evidence was found in any patient of hemorrhage or subcapsular hematoma.Conclusions These data suggest that this novel transhepatic approach provides an effective and safe route for diagnostic and interventional cardiac catheterization in children.