Percutaneous transhepatic dual chamber pacing in children with Fontan circulation.

Abstract

Permanent pacing is often required following the Fontan operation and is usually performed epicardially as there is no direct access to the ventricle from the systemic veins. Dual chamber endocardial pacing was achieved by the transhepatic approach in two children with Fontan circulation. The patients were a 7 year old boy with left atrial isomerism, single ventricle with pulmonary stenosis, interrupted inferior vena caval vein with azygous continuation, and direct drainage of the hepatic veins to the right sided atrium, and a 6 year old girl with tricuspid atresia. This approach to endocardial pacemaker implantation is potentially of considerable value in patients who do not have direct access to the ventricle from the systemic veins. (Heart 1997;77:574-575) Keywords: transhepatic endocardial pacing; children; Case 1 A 7 year old boy with left atrial isomerism, single ventricle with pulmonary stenosis, interrupted inferior vena caval vein with azygous continuation, and direct drainage of the hepatic veins to the right sided atrium developed complete heart block five years after palliative superior cavopulmonary shunt. He had decreased exercise tolerance and exercise induced ventricular tachycardia for which it was decided to insert a dual chamber endocardial pacemaker via the transhepatic route.

Transhepatic radiofrequency ablation of a cavotricuspid isthmus–dependent atrial flutter

“…The hepatic vein has been used as a long-term access route for noncardiovascular interventions, including hemodialysis and total parenteral nutrition 5, 6. This technique has also been well documented in pediatric patients for catheterization of the left side of the heart.…”

Transvenous Atrial Pacing from the Superior Vena Cava Stump after the Hemi‐Fontan Operation—A New Approach

“…Conventionally, an epicardial approach has been taken especially when the need for pacing has been apparent at the time of the superior cavopulmonary connection. Alternative approaches include direct puncture of the right atrium during open chest surgery to improve the thresholds and sensing characteristics and transvenous approaches through the femoral or hepatic veins …”

Fechamento percutâneo de comunicação interatrial por punção trans-hepática

“…If the usual venous access routes are not available, the transhepatic puncture may be performed for prolonged venous access, as is the case for parenteral nutrition or chemotherapy 8 , repeated myocardial biopsies 9 and pacemaker implantation 10 . Transhepatic puncture may also be used as the fi rst option to perform diagnostic or therapeutic heart catheterization in prematures, as it allows the use of larger sheaths.…”