Fechamento percutâneo de comunicação interatrial por punção trans-hepática

Abstract

absent, and that it continued as an azygos towards the superior vena cava (SVC). We then punctured the right internal jugular vein and positioned the guide wire into the left inferior pulmonary vein. We then performed all the classic steps to close the ASD, without succeeding in obtaining a good position to release the prosthesis. In view of this, the procedure was interrupted, and re-planned. After obtaining the authorization of the patient and her parents, the procedure was carried out two weeks later by transhepatic puncture of the hepatic vein following the steps below: 1) General anesthesia with endotracheal tube. 2) Transesophageal echocardiogram. 3) Abdominal ultrasound. 4) IV cephalothin 2.0 grams. 5) Preparation of the region of the right hypochondrium and transhepatic puncture in the upper part of the inferior third of the liver at the level of the anterior axillary line using a Chiba 0.018 needle (Cook Inc.) (fi gure 2). The needle was positioned in parallel to the fl oor of the hemodynamics room and directed towards the spine. It was kept 2 cm away from it. The stylet was removed and a 5 ml-syringe with nonionic contrast medium was connected. The needle was slowly withdrawn and we aspirated until blood began to fl ow. At this point, we manually injected a small amount of contrast medium, and confi rmed the position in the hepatic vein (fi gure 3). A 0.035 guide wire was then introduced and positioned in the right atrium. We then performed the dilation with a 7F introducer, then introduced the 7F hemaquet, administered 5,000 U/kg of IV heparin, measured the pressures with a multipurpose catheter, positioned the catheter in the left superior Percutaneous atrial septal defect (ASD) closure is done by inferior vena cava (IVC) routinely. Occasionally this access is not possible due to obstruction or congenital absence of IVC. This case report shows the percutaneous implantation of an Amplatzer device to close large ASD in a patient with congenital absence of IVC. The procedure was done by a transhepatic punction of the hepatic vein with a Chiba needle (Cook Inc.) with no complications, taking the same amount of time, as the usual access. The transhepatic punction is a good option to central venous access in patients without other alternatives. The hepatic veins are large which make it possible to use large sheaths safely, even in neonates with low weight. This technique should be remembered, when it is impossible to use the usual venous access. CASE REPORTAn eighteen-year-old female patient was referred for percutaneous closure of atrial septal defect (ASD). On physical examination she had signs of right ventricle enlargement, fi xed splitting of the second heart sound, ejection systolic murmur in the upper left sternal edge (LSE) and mesodiastolic murmur in the lower LSE.Supplementary tests evidenced sinus rhythm and second degree right branch block on electrocardiogram, slight increase of heart area on thorax x-ray, and OS-ASD with 18 mm of diameter on transesophageal echocardiogram (TE-ECHO) (fi gure 1...

Percutaneous closure of ostium secundum atrial septal defect using left internal jugular vein access in a child with situs inversus and absence of inferior caval vein

“…1 Transhepatic puncture has been used as an alternative venous access for the percutaneous atrial septal defect closure in other particular situations. [2][3][4][5] However, as an increased risk of complicationsespecially bleedingwas observed, this approach should be used only in the absence of other safer options, especially in patients with unusual liver anatomy, as in this case report.…”

Percutaneous transhepatic approach for cryoballoon pulmonary vein isolation in a patient with persistent atrial fibrillation and interruption of the inferior vena cava

“…Although there is no consensus on how to close the hepatic parenchymal tract, few cases have documented how hemostasis was achieved. Some cases have used manual pressure or placed patients in the right lateral decubitus position, 8 , 12 while others have achieved hemostasis with the placement of intrahepatic coils 10 , 13 or Gelfoam 14 or bipolar radiofrequency energy to cauterize/coagulate the adjacent hepatic parenchymal tissue. 3 When hepatic parenchymal plugs are used, it is imperative to ensure no embolization or migration into the hepatic vein itself, as it could be a nidus of infection or result in venous occlusion.…”

Transjugular closure of a two-hole atrial septal defect in a child with iliac vein thrombosis

“…We preferred the transjugular access over the transhepatic access due to the complications potentially associated with the latter, including retroperitoneal bleeding, hemobilia, and hepatic abscess, which can be avoided using the transjugular approach. [17] We believe that the jugular approach provides a simpler and safer alternative to the transhepatic approach.…”