Pediatric central venous catheterization: The Role of the Aortic Valve in Defining the Superior Vena Cava-Right Atrium Junction

• Published in: Clinical anatomy (New York, N.Y.) N.Y.), 2019-09, Vol.32 (6), p.778-782
• Main Authors: Hinton, Lucy R, Fischer, Nicholas J, Taghavi, Kiarash, O'Hagan, Lomani A, Mirjalili, Seyed Ali
• Format: Article
• Language: English
• Subjects: Anatomic Landmarks - anatomy & histology; Aortic Valve - anatomy & histology; Aortic Valve - diagnostic imaging; Catheterization, Central Venous - methods; Child; Child, Preschool; Cross-Sectional Studies; Heart Atria - anatomy & histology; Heart Atria - diagnostic imaging; Humans; Infant; Infant, Newborn; Intercostal Muscles; Retrospective Studies; Thoracic Cavity - anatomy & histology; Thoracic Cavity - diagnostic imaging; Tomography, X-Ray Computed; Vena Cava, Superior - anatomy & histology; Vena Cava, Superior - diagnostic imaging
• ISSN: 0897-3806; 1098-2353
• DOI: 10.1002/ca.23399

The aortic valve (AV) has been used as a surrogate marker for the superior vena cava-right atrium (SVC-RA) junction during the placement of central venous catheters. There is a paucity of evidence to determine whether this is a consistent finding in children. Eighty-seven computed tomography scans of the thorax acquired at local children's hospitals from April 2010 to September 2011 were retrospectively collected. The distance between the SVC-RA junction and the AV was measured by dual consensus. The cranio-caudal level of the junction and the AV were referenced to the costal cartilages (CCs) and anterior intercostal spaces (ICSs). The results confirmed that the SVC-RA junction has a variable relationship to the AV. The junction was on average 3.1 mm superior to the AV. This distance increased with age. In the 7 years old age group: 4 mm (range: -11 to 16 mm). The surface anatomy of the SVC-RA junction was variable, ranging from the second ICS to sixth CC. The SVC-RA junction has a predictable relationship to the AV, and this can be used as an adjunct marker for accurate placement of central venous catheters except in the smallest neonates. Clin. Anat. 32:778-782, 2019. © 2019 Wiley Periodicals, Inc.