Pediatric central venous catheterization: The Role of the Aortic Valve in Defining the Superior Vena Cava-Right Atrium Junction.

Abstract

The aortic valve (AV) has been used as a surrogate marker for the superior vena cava-right atrium (SVC-RA) junction during the placement of central venous catheters. There is a paucity of evidence to determine whether this is a consistent finding in children. Eighty-seven computed tomography scans of the thorax acquired at local children's hospitals from April 2010 to September 2011 were retrospectively collected. The distance between the SVC-RA junction and the AV was measured by dual consensus. The cranio-caudal level of the junction and the AV were referenced to the costal cartilages (CCs) and anterior intercostal spaces (ICSs). The results confirmed that the SVC-RA junction has a variable relationship to the AV. The junction was on average 3.1 mm superior to the AV. This distance increased with age. In the <1-year-old age group, the junction was on average 1.3 mm superior to the AV (range: -6 to 11 mm). In the 1-2 years old age group: 3.5 mm (range: -8 to 15 mm). In the 3-6 years old: 3.8 mm (range: -9 to 13 mm). In the >7 years old age group: 4 mm (range: -11 to 16 mm). The surface anatomy of the SVC-RA junction was variable, ranging from the second ICS to sixth CC. The SVC-RA junction has a predictable relationship to the AV, and this can be used as an adjunct marker for accurate placement of central venous catheters except in the smallest neonates. Clin. Anat. 32:778-782, 2019. © 2019 Wiley Periodicals, Inc.