Cardiac catheterization in children with septal defects usually uses which approach, and why?

• A. Left femoral artery; to access the left heart
• B. Right femoral vein; to access the left heart
• C. Jugular vein; to access the left heart
• D. Subclavian artery; to access the left heart

Answer: (B)

Accessing the left heart through a venous route is preferred in children with septal defects because the defect provides a natural path from the right atrium to the left atrium. By entering through the right femoral vein, the catheter travels up to the right atrium and can cross the atrial septal defect into the left atrium (and then to the left ventricle if needed). This approach allows assessment of left-sided pressures and the shunt without having to puncture an artery.

Arterial routes, such as the left femoral artery or other arterial access points, involve arterial puncture in small children and carry higher risk of vascular or thrombotic complications. Jugular or subclavian arterial access would similarly involve arterial entry. Therefore, the venous route via the right femoral vein is the safest and most practical way to evaluate a septal defect and its hemodynamics.