Infant’s Cardiac Valve Replaced Through the Liver

A novel surgical procedure successfully placed a tricuspid valve in a one-year-old infant using a catheter through the liver, since infants’ blood vessels are too small to transport it to the heart.

Pediatric cardiologists at University Hospitals Leuven (UZ Leuven, Belgium) previously replaced the tricuspid cardiac valve in the child just after birth, via an open-heart procedure. However, the valve was quickly broken down due to the infants’ immune defenses, and after just one year, the patient needed a new valve. A further complication was that the specific cardiac valve required for the intervention was only available in a larger standard format, which made it necessary to trim it down to fit the patient.

The surgeons claim that the liver is a good alternative for catheterization because it acts like a sponge, is relatively easy to perforate, and is made up of large sheaths of tissue. However, there are risks involved, since the opening must be well-sealed after the intervention to prevent potentially fatal bleeding. The surgical team therefore included both a liver surgeon and a cardiac surgeon who remained in standby in the event that the catheterization technique failed and open-heart surgery became necessary.

“Any further open-heart surgery would entail severe health risks and follow-up procedures, so we opted for a percutaneous intervention via a catheter,” says cardiologist Prof. Marc Gewillig, MD, PhD, head of pediatric cardiology at UZ Leuven. “Normally we would put a catheter through a vein in the neck or groin to the heart. But in children who weigh less than ten kilograms, these blood vessels are too small for such a catheter, which is 7 to 8 millimeters wide. That is why we used an alternative access point through the liver.”

The hepatic veins drain de-oxygenated blood from the liver and blood cleaned by the liver (from the stomach, pancreas, small intestine and colon) into the inferior vena cava. They arise from the substance of the liver, more specifically from the central vein of a liver lobule; none of the hepatic veins have valves. The upper groups of veins typically arise from the posterior aspect of the liver, and are larger than the lower veins.

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