Agnoletti Gabriella, Marini Davide, Legendre Antoine, Boudjemline Younes, Bonnet Damien
Service de cardiologie pédiatrique, centre de référence des malformations congénitales complexes M3C, groupe hospitalier hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris, France.
Arch Cardiovasc Dis. 2008 Jun;101(6):413-8. doi: 10.1016/j.acvd.2008.05.012. Epub 2008 Aug 26.
Occlusion of the femoral veins is a frequent complication of cardiac catheterization in small children. If the venous femoral approach is not available, a jugular approach is generally used for catheterization of the right heart.
To describe and evaluate an alternative retrograde approach for catheterization of the right heart in small children with a ventricular septal defect or single ventricle.
Between January 2004 and January 2007 we attempted retrograde catheterization of the right heart via the femoral artery using a 4 French sheath in eight children with occluded femoral veins. The procedure was planned under awake sedation.
Median age was five months (range 4-60) and median weight was 5 kg (range 4-10). Diagnoses were as follows: single ventricle (n = 6); pulmonary atresia and ventricular septal defect (n = 1); complex transposition of the great arteries (n = 1). The procedure was successful in six patients, enabling measurement of pulmonary arterial pressure and pulmonary angiography. The procedure was abandoned in two patients because of ventricular arrhythmias. One patient had concomitant dilatation of aortic recoarctation and one had embolization of aortopulmonary collaterals. With the exception of transient ventricular arrhythmias, no acute or late complications occurred. In particular, transient or permanent atrioventricular block, occurrence of new aortic insufficiency, and acute or late thrombosis of the femoral artery were not observed.
Retrograde catheterization of the right heart in small children is feasible and relatively safe. This technique can be performed without general anaesthesia and avoids a jugular approach.
股静脉闭塞是小儿心脏导管插入术常见的并发症。若无法采用股静脉途径，一般采用颈静脉途径进行右心导管插入术。
描述和评估一种用于患有室间隔缺损或单心室的小儿右心导管插入术的逆行替代方法。
在2004年1月至2007年1月期间，我们对8例股静脉闭塞的儿童使用4F鞘管经股动脉尝试进行右心逆行导管插入术。该操作在清醒镇静下进行规划。
中位年龄为5个月（范围4 - 60个月），中位体重为5千克（范围4 - 10千克）。诊断如下：单心室（n = 6）；肺动脉闭锁合并室间隔缺损（n = 1）；完全性大动脉转位（n = 1）。6例患者手术成功，能够测量肺动脉压力并进行肺血管造影。2例患者因室性心律失常放弃手术。1例患者合并主动脉缩窄扩张，1例患者发生主肺动脉侧支栓塞。除短暂性室性心律失常外，未发生急性或晚期并发症。特别是，未观察到短暂或永久性房室传导阻滞、新的主动脉瓣关闭不全的发生以及股动脉急性或晚期血栓形成。
小儿右心逆行导管插入术可行且相对安全。该技术无需全身麻醉即可进行，且避免了颈静脉途径。
