REGULAR CONTENT
Final ID
667
Type
Educational Exhibit-Poster Only
Authors
Y Golowa1, A Nagorna2, B Cahn2, M Jagust1, H Kalia1, R Pass1, A Zaidi1, J Cynamon1
Institutions
1Montefiore Medical Center, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY
Purpose
Patients with congenital heart disease (CHD) can present with congestive hepatopathy in the setting of longstanding right heart failure, and frequently need liver biopsies with pressure measurements. At our institution, transvenous liver biopsies are often performed at the time of cardiac catheterization precluding patient from undergoing a separate procedure.CHD patients have multiple corrective surgeries including Fontan in which the superior (SVC) and inferior vena cava (IVC) are ultimately anastamosed to the pulmonary artery (PA), with the IVC anastomosis via an extracardiac PTFE conduit or intra-atrial baffle. The SVC to PA anastomosis and IVC conduit/intra-atrial baffle may not aligned which may make it difficult to advance the stiff biopsy cannula from the internal jugular vein (IJ) into the hepatic vein. Liver biopsy can be achieved from a femoral venous approach using the transfemoral transcaval technique (TFTC) in patients where IJ access is difficult or not possible. In addition, when the femoral vein is the desired access for cardiac catheterization, the same access can be used without requiring another puncture.
Materials & Methods
In a retrospective review of patients who had transvenous liver biopsies, thirteen patients were identified as having CHD. Congenital heart defects, corrective surgeries, site of venous access to obtain biopsy specimen, portosystemic pressures, and pathology results were recorded and reviewed.
Results
Fourteen transvenous liver biopsies were performed in thirteen patients with CHD. Twelve out of thirteen patients had a Fontan procedure. Seven biopsies were performed from an IJ approach and seven from a TFTC approach. Thirteen out of fourteen biopsies obtained adequate specimen. A moderate sized hematoma was reported in one patient with liver biopsy from an IJ approach in 2011 requiring four units of blood transfusion. No complications were reported via TFTC approach.
Conclusions
Transvenous liver biopsies are often indicated in patients with CHD and can be performed in conjunction with cardiac catheterization. Both IJ and TFTC approach can be used. TFTC may be advantageous in patients with a Fontan or who have femoral access from cardiac catheterization.
Final ID
667
Type
Educational Exhibit-Poster Only
Authors
Y Golowa1, A Nagorna2, B Cahn2, M Jagust1, H Kalia1, R Pass1, A Zaidi1, J Cynamon1
Institutions
1Montefiore Medical Center, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY
Purpose
Patients with congenital heart disease (CHD) can present with congestive hepatopathy in the setting of longstanding right heart failure, and frequently need liver biopsies with pressure measurements. At our institution, transvenous liver biopsies are often performed at the time of cardiac catheterization precluding patient from undergoing a separate procedure.CHD patients have multiple corrective surgeries including Fontan in which the superior (SVC) and inferior vena cava (IVC) are ultimately anastamosed to the pulmonary artery (PA), with the IVC anastomosis via an extracardiac PTFE conduit or intra-atrial baffle. The SVC to PA anastomosis and IVC conduit/intra-atrial baffle may not aligned which may make it difficult to advance the stiff biopsy cannula from the internal jugular vein (IJ) into the hepatic vein. Liver biopsy can be achieved from a femoral venous approach using the transfemoral transcaval technique (TFTC) in patients where IJ access is difficult or not possible. In addition, when the femoral vein is the desired access for cardiac catheterization, the same access can be used without requiring another puncture.
Materials & Methods
In a retrospective review of patients who had transvenous liver biopsies, thirteen patients were identified as having CHD. Congenital heart defects, corrective surgeries, site of venous access to obtain biopsy specimen, portosystemic pressures, and pathology results were recorded and reviewed.
Results
Fourteen transvenous liver biopsies were performed in thirteen patients with CHD. Twelve out of thirteen patients had a Fontan procedure. Seven biopsies were performed from an IJ approach and seven from a TFTC approach. Thirteen out of fourteen biopsies obtained adequate specimen. A moderate sized hematoma was reported in one patient with liver biopsy from an IJ approach in 2011 requiring four units of blood transfusion. No complications were reported via TFTC approach.
Conclusions
Transvenous liver biopsies are often indicated in patients with CHD and can be performed in conjunction with cardiac catheterization. Both IJ and TFTC approach can be used. TFTC may be advantageous in patients with a Fontan or who have femoral access from cardiac catheterization.