Cardiovascular Intervention in Neonates Using an Umbilical Vein Approach.

Ying-Tzu Ju,Yu-Jen Wei,Jing-Ming Wu,Yung-Chieh Lin,Min-Ling Hsieh,Jieh-Neng Wang

doi:10.3390/children8111017

Abstract

Cardiovascular catheterization has been applied in infant treatment for several decades. To date, considerable research attention has been paid to cardiovascular catheterization in small neonates. However, peripheral vascular routes of catheterization are possible obstacles for interventionists. Umbilical vein catheterization has been reported as a route for neonates, although few attempts have been made to investigate this approach. This study aimed to retrospectively review cardiovascular intervention using the umbilical vein approach as applied to infants admitted to a tertiary center from 2017 to 2020. Details including the perinatal variables, indication diagnoses, and procedure devices were collected. The enrollment included a total of 16 cases representing 17 intervention events, with infants born at a gestation age of 22–39 weeks and body weight ranging from 478 to 3685 g at the time of the procedure. The postnatal age ranged from 1 to 27 days. The catheter sizes ranged from 4 to 11 Fr. Indications included being admitted for patent ductus arteriosus occlusion (n = 15), balloon pulmonary valvuloplasty (n = 3), balloon atrial septostomy (BAS) (n = 3), pulmonary valve (PV) perforation (n = 1), and two interventions for catheter placement for continuous venovenous hemofiltration. The success rate for cardiovascular catheterization was 88.2% (15/17). There were two patients for which cannulation failed due to ductus venosus closure: one intraabdominal hemorrhage complication during continuous venovenous hemofiltration (CVVH), and one cardiac catheterization failure of PV perforation due to failure to insert the guiding catheter into the right ventricular outflow tract. Based on these findings, we conclude that cardiac catheterization and the placement of a large-sized catheter through an umbilical vein in a small infant represents a safe and time-saving method when catheterization is required.

Highlights

Advances in the medical and surgical management of neonates are often predicated upon secure vascular access [1]
After PDA occlusion, the umbilical vein was used for continuous venovenous hemofiltration (CVVH)
A total of 17 interventional events (15 cardiac catheterization and 2 CVVH) in 16 infants were included in the analysis

Summary

Introduction

Advances in the medical and surgical management of neonates are often predicated upon secure vascular access [1]. The percutaneous approach to central venous cannulation is sometimes difficult in neonates, especially in premature infants. The femoral vein, or femoral artery, is used for vascular access in the cardiac catheterization of children. Even with ultrasound guidance, setting up vascular access in infants remains challenging, especially in premature infants with a birth body weight of less than 1000 g [4,5]. The use of the umbilical vessel in cardiac catheterization was first reported in 1961 for angiography, but has rarely been mentioned of late due to recent advances in cannulation techniques [7]. The increasing frequency of even smaller and lower body weight premature neonates is resulting in an increased demand for less invasive cardiovascular interventions and central venous cannulation. We report our experiences of using the umbilical vein as a route for intervention

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