New approach to catheterization of the heart in infants and children.

Abstract

The peripheral blood vessels of infants and children are difficult to cannulate and to repair. The lumen will accommodate only small bore catheters and these are harder to manoeuvre, and impair the quality of angiograms. Lengthening of the procedure and an increase in the amount of contrast medium which is needed both contribute to the morbidity. To our knowledge, cannulation of the internaljugular vein and/or carotid artery for purpose of heart catheterization in humans has never been reported. The technique of this approach is described in detail and illustrated. A brief outline of the advantages and disadvantages of the procedure is given. The fact that the technique requires an operator experienced in handling major vessels is stressed. In all, 705 approaches to the great vessels of the neck have now been performed, and both the potential complications and those encountered are listed. With strict adherence to andfamiliarity with the technique the procedure is safe and offers, we believe, decided advantages.Cannulation of arteries and veins for cardiac catheterization in the adult is usually easy. In the newborn and infants, however, it may be very difficult and time consuming. In the first two months of life mortality rates are very high, of the order of 6 per cent (Burchell and Ongley, I968). The duration of the procedure is directly related to the mortality and morbidity in this category of patient (Banyai and Gordon, i966), and the investigation should, in general, seek only those data essential to an accurate diagnosis. Because of the patient's size, difficulties are posed by the length-gauge ratio of the catheter and the amount of dye in relation to body weight to be delivered in unit of time (Banyai and Gordon, I966).The technique we describe was developed between I965 and I966 by one of us (G.A.) and it has proved to be useful in the newborn, in infants, and in children up to the age of 3 to 4 years. We have often used it in children between 4 and 7 years of age, and occasionally in young adults. The approach is strongly indicated when previous catheterizations or other procedures have been carried out at or in the vicinity of the usual areas of venous or arterial cannulation. This is often the case in our patient population.To our knowledge open cannulation of the internal jugular vein and/or the common carotid artery

Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

“…Diagnostic cardiac catheterization via carotid cutdown in pediatric patients was first performed in the 1960s by Azzolina et al, 2 although this approach did not gain wide acceptance at that time. In the 1970s, percutaneous sheath catheterization was developed and was found to have a lower incidence of arterial complications compared with the arterial cutdown technique, and the femoral arterial route became the favored approach for retrograde left heart catheterization.…”

“…Patient characteristics, including age and weight at time of procedure, cardiac diagnosis, and indication for the catheterization were reviewed. The primary indication for PCA was one of the following factors: (1) low patient weight (with weight <2.5 kg thought by the authors to be at highest risk for vessel trauma from femoral artery catheterization), (2) angle of approach for intervention (all interventions across the aortic valve, and some interventions on the arterial duct or on Blalock-Taussig [BT] shunts were deemed to be best approached by PCA), and (3) need for left heart intervention when both femoral arteries were occluded. When available, the following data Background-Surgical cutdown for access to the common carotid artery provides a more direct route for certain pediatric cardiac interventions and avoids femoral artery injury in small infants.…”

“…In addition, the carotid approach is a more direct route for interventions directed at the aortic valve, some arterial ducts, and some surgical systemic-pulmonary arterial shunts. 1 As first described in children by Azzolina et al 2 in 1973, surgical carotid cutdown involved placement of a purse-string suture, followed by creation of a longitudinal arteriotomy through which catheters were placed, and tying of the purse-string suture at the end of the case. Although this approach has been widely used and is considered to be safe and effective, [3][4][5][6] it is invasive, time consuming, requires an available surgeon, and results in scarring that is cosmetically less appealing and could complicate repeat vascular access in the same vessel.…”

Angiographic follow‐up of infants and children undergoing percutaneous carotid artery interventions

“…However, complex catheter‐based interventions are occasionally best approached from the CA. While the surgical cutdown of the CA with surgical assistance has been well described there is little description in the literature regarding the fate of the CA following surgical cutdown. Importantly, a review of such patients was published by Borghi et al and found that in 1/3 of patients, important CA stenosis or complete occlusion followed surgical cutdown .…”

The carotid arterial approach for balloon dilation of critical aortic stenosis in neonates—immediate results and follow-up

“…of technical difficulties and vascular complications consequent upon the use of the femoral or umbilical arteries as the conduit for the catheter. 9 ' 16 In 1973, Azzolina et al 17 described the use of the carotid artery for diagnostic pediatric catheterization. In 1990, Fischer et al 18 first reported cutting down on the right common carotid artery as a means of achieving balloon dilation of the stenotic aortic valve in neonates.…”