Two Cases of Interventional Cardiac Catheterization Via a Transhepatic Approach

Abstract

We report two cases of interventional cardiac catheterization via a transhepatic approach. Patient 1 （age, 1 year; weight, 5.8 kg） had tetralogy of Fallot and underwent percutaneous transluminal angioplasty for left pulmonary artery stenosis. Patient 2 （age, 25 years; weight, 51 kg） had polysplenia, and underwent coil embolization for a tortuous patent ductus arteriosus. Because these patients had either bilateral femoral vein obstruction or interruption of the inferior vena cava, and both had right internal jugular vein obstruction, we chose a transhepatic approach. The procedures were performed under general anesthesia. Hepatic vein punctures were performed by hepatic surgeons with ultrasound guidance; access was obtained by a single needle puncture within 20 min in both patients. Stable manipulation of the catheter was achieved, and the intervention was successful without complications. After the intervention, the transhepatic tract was closed with oxidized cellulose （SURGICEL^®） introduced through the sheath. No intrahepatic or retroperitoneal hemorrhage was observed in either patient. In patients with interruption of the inferior vena cava or obstruction of the femoral vein and obstruction of the jugular vein, the traditional venous access sites are unavailable. Cardiac catheterization via a transhepatic approach is a safe and effective option for this condition and can be performed in infants. Intraoperative hemostasis is important; furthermore, closure of the transhepatic tract with oxidized cellulose is a simple and useful procedure. To ensure patient safety, it is essential to involve physicians with expertise and familiarity with the puncture procedure and maintenance of hemostasis in the hepatic vein.