Percutaneous catheterization in children.

Abstract

Despite the widespread employment of the percutaneous method of catheterization and the voluminous amount of material appearing in the literature on the subject, little has been written about this important technic in children. The vast number of percutaneous vascular examinations are performed in adults for diagnosis and evaluation of the sequelae of atherosclerosis, i.e., stenosis and thrombosis. Because these represent degenerative changes, they are seldom found in the pediatric age group. This, no doubt, is one reason there has been little emphasis on the percutaneous method of vascular entry in children. Schobinger and Ruzicka (6) in their excellent book, Vascular Roentgenology, devote an entire chapter to angiography in children. They state that the percutaneous puncture of arteries in children is difficult and the examination must be performed as a rule after a cut-down. However, Lurie et al. (5) in 1963 reported in detail their experience with the Seldinger technic and concluded that examination of the vascular system in children by the percutaneous method was practical and valuable. In children the majority of vascular abnormalities are congenital. With the advancement of modern cardiac surgery, increasing emphasis has been placed on the accurate preoperative diagnosis of abnormalities of the heart and great vessels. Angiocardiography is extremely important in evaluating these diseases. At most centers the cut-down method of vascular entry is employed to introduce an angiographic catheter. End-hole catheters are not satisfactory for high-pressure injections into the heart because of the risk of myocardial perforation and the greater incidence of catheter recoil. With the development of the Mylar sheath technic (1, 2), this disadvantage of the percutaneous method has been eliminated, and any type catheter or instrument can be introduced percutaneously without the necessity of a cut-down. Prior to March 1965, only a sporadic few percutaneous vascular examinations were performed on children at the University of California at Los Angeles. In the ten-month interval since March, 54 arterial catheterizations were carried out with the percutaneous method of entry. The youngest child was two years of age, and the average age was eleven and one-half years. Twenty examinations were performed in children of ten years or less and 7 in children of five years or less. The majority of these studies were undertaken for evaluation of the left ventricle and aorta, using closed-end catheters inserted through the Mylar sheath. During this time interval, 14 additional arterial studies without the sheath were also performed (Table I). In addition, right heart catheterization and venography following puncture of the femoral vein were carried out twenty times.