Selective coronary angiography via antegrade venous route in congenital cyanotic heart disease

Abstract

An antegrade venous technique was utilised to perform selective coronary angiography in cyanotic infants and children. The procedure was successful in 88% (37/42) cases and excellent quality angiograms were recorded. The importance of proper catheter selection and details of the technique are discussed.

Anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman

“…We believe that the selective angiographic study is necessary, because it allows analysis of left coronary anatomy, flow balance between the left coronary and collateral vessels, and a more correct planning of the surgical approach. The catheterization, using the femoral vein approach, of coronary arteries arising from the aorta in children with congenital heart diseases has been previously described 9 and is a simple procedure, because in children the aorta is small in diameter. But difficulties exist for selective catheterization of the left coronary artery arising from the pulmonary trunk in adults, due to the large trunk diameter and the curve of the catheter at the tricuspid valve.…”

Transvenous coronary arteriography via ventricular septal defect for infants and children with tetralogy of fallot

“…Anatomically more important, the right coronary artery ostium is located at a site close to the VSD and anterior in TOF [7,8,10], making the right coronary catheter insertion easier. In cases of complex congenital heart disease (TOF, truncus arteriosus, double outlet right ventricle), a selective coronary arteriography is possible through VSD using a technique similar to that usually applied in the right heart catheterization [6]. In young children, up and down movements of the aortic root occur due to respiration and cardiac systole, but this cyclic deviation is very small and probably causes no technical difficulty.…”

“…During transvenous coronary arteriography through a VSD, the selective coronary catheters run through the two cardiac valves, such as the tricuspid and the aortic valves, requiring some technical skill compared to the transarterial arteriography, which does not involve the valves. Loya et al [6] preliminaryly reported the selective coronary angiography via the antegrade venous route and showed the need of a newly designed catheter to simplify the procedure. We have independently developed this transvenous procedure and made two preshaped catheters for cases with TOF.…”

“…The tips of newly designed catheters have upward angulation, which are different from other commercially available catheters (Fig. 1) [6], and these facilitate entry into the coronary ostium via antegrade transvenous approach. We utilized the guidewire technique to exchange the catheter.…”

“…Recently, selective coronary angiography via venous approach has been reported in two newborns with d-transposition of the great arteries by Day et al [5] in 1989 and in 42 patients with cyanotic congenital heart disease by Loya et al [6] in 1993.…”