Use of the internal jugular vein approach in balloon dilatation angioplasty of pulmonary artery stenosis in children

Generally, the approach used for balloon dilatation angioplasty for pulmonary artery stenosis in children is from the femoral vein. However, sometimes an alternative approach must be used because of femoral vein occlusion or some other reason. As reports have been limited about the results achieved using the internal jugular vein approach in pediatric interventional catheterization, we report on the internal jugular vein approach in balloon dilatation angioplasty of the pulmonary artery for pediatric patients and discuss the advantages of this approach. From 1991 through 1993 15 balloon dilatation angioplasties of the pulmonary artery using the internal jugular vein approach were performed in 14 pediatric patients, ranging in age from 4 months to 13 years. Based on this experience, we have evaluated this method from several viewpoints including the technique and possible complications. All procedures were performed without complications in all patients; and by inserting a 7 sheath it was even possible to perform balloon dilatation in a 4-month-old infant. A sheath as large as 9 F could be inserted in other patients, and the double-balloon method was used in seven patients. The Seldinger method was also available when the balloon catheter was too large to use with a sheath. For pediatric interventional cardiac catheterization, it was found that the internal jugular vein approach is relatively safe and reliable. Furthermore, catheterization of the pulmonary artery was easier with the internal jugular vein approach than with the femoral vein approach.