Retrograde catheterization of the right heart in patients with occluded femoral veins

Abstract

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.