Shim D, Lloyd T R, Cho K J, Moorehead C P, Beekman R H
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor 48109, USA.
Circulation. 1995 Sep 15;92(6):1526-30. doi: 10.1161/01.cir.92.6.1526.
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.
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 On completion of the catheterization, the sheath was withdrawn and a 3-mm steel coil was placed in the parenchymal tract between the hepatic vein and liver capsule.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.
These data suggest that this novel transhepatic approach provides an effective and safe route for diagnostic and interventional cardiac catheterization in children.
在一些患有先天性心脏病的儿童中，无法通过常规静脉通路进行心脏导管插入术。本研究探讨一种用于儿童心脏导管插入术的新型经肝静脉途径，并评估其有效性和安全性。
在透视引导下，使用22号千叶针进行经皮经肝穿刺。在更换导丝后，将5F至8F鞘管置于右心房下部并进行心脏导管插入术。导管插入术完成后，拔出鞘管，并在肝静脉与肝包膜之间的实质通道内放置一个3毫米的钢圈。在经肝导管插入术前和术后进行肝功能检查，并在术后24小时进行腹部超声检查以评估肝脏情况。18例尝试经皮经肝心脏导管插入术的儿童中有17例成功完成。患者年龄为30±8个月（平均±标准误；范围为1天至9岁），体重为10.5±1.5千克（3.1至27.5千克），平均右心房压力为10±1毫米汞柱（5至19毫米汞柱）。从最初穿刺针到进入右心房的时间为6.2±1.2分钟。所有17例儿童均成功进行了诊断性导管插入术，5例儿童进行了额外的介入操作。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升高至78±8 IU/L（P = 0.06），但丙氨酸转氨酶和γ-谷氨酰转肽酶未发生变化。经肝导管插入术后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迹象。
这些数据表明，这种新型经肝途径为儿童诊断性和介入性心脏导管插入术提供了一种有效且安全的途径。
