Vascular access for cardiac catheterization of patients with congenital heart disease

Abstract

Pediatric cardiac catheterization has progressed over the past 50+ years into a sub-specialty with numerous diagnostic and interventional procedures for the care of children with congenital heart disease. There are increasing numbers of patients who are surviving with complex congenital heart lesions, as well as more therapeutic interventional procedures being performed in the catheterization laboratory. Obtaining vascular access in infants and children with multiple prior catheterizations can pose a significant challenge to the pediatric interventional cardiologist. In the early years of cardiac catheterization, cutdown procedures and direct puncture methods were utilized to perform diagnostic cardiac evaluations. These procedures have fallen out of favor as newer, less invasive methods of vascular access have developed. The cutdown procedures of the arterial and venous vessels have gradually given way to percutaneous procedures for vascular access. We have found that standard percutaneous methods can be augmented with cutdown procedures of the vessels used in catheterization. In addition, numerous unique methods for vascular access have developed. These include carotid, translumbar and transhepatic. With adequate experience, these procedures can be performed safely and effectively when routine vascular access for catheterization is not an option. Vascular access for catheterization is dependent on patient characteristics, operator skills, and the procedure being performed.