CASE REPORT Successful Femoral Vessel Puncture Facilitated by Using a J-Tipped Hydrophilic Guidewire in Pediatric Cardiac Catheterization Satoshi Masutani Æ Hideaki Senzaki Received: 17 April 2007 / Accepted: 20 June 2007 / Published online: 29 August 2007 Ó Springer Science+Business Media, LLC 2007 Abstract Vascular access is an important part of cardiac catheterization, but it is extremely difficult in some cases. We present two cases in which a J-tipped hydrophilic guidewire inserted from the contralateral vessel facilitated successful vascular access after initial access failure by conventional method using anatomical landmark. Keywords Guidewire Á Puncture Á Vascular access Vascular access is arguably the most important part of cardiac catheterization. It is the first step in many clinical procedures, and the manner in which it is achieved affects not only the procedure at hand but all future cardiac catheterizations as well [1]. However, in pediatric cathe- terization, sometimes vascular access could be extremely difficult due to hypoplasia of vessels, vasospasm induced by hemodynamic instability or unsuccessful initial trial, in addition to the age-related difficulty of small vessel size. In this report, we present two cases in which a J-tipped hydrophilic guidewire inserted via the contralateral vessel facilitated successful vascular access after initial failure by the conventional method using anatomical landmark. Case Report The first case was a 1-month-old female infant (body weight: 3.5 kg) with tetralogy of Fallot complicated with pulmonary atresia and major aortopulmonary collateral arteries (MAPCAs). The patient was scheduled for cardiac catheterization for preoperative evaluation of MAPCAs and potential coil embolization of the vessels. However, femoral artery puncture by the conventional method was unsuccessful after a number of needle passes by several operators. To access the arterial tree, we inserted a 0.025- in. hydrophilic guidewire (angled-tip Radifocus, Terumo 1 ) from the right femoral vein and advanced it to the left femoral artery through the ventricular septal defect, as illustrated in Fig. 1A. We intentionally created a loop at the tip of the wire using the iliac bifurcation (Fig. 1B). This provided clear identification of the vessel location and width and, hence, successful arterial puncture with the first needle pass. The second case was a 9-month-old girl (body weight: 7.5 kg) with pulmonary stenosis who underwent cardiac catheterization for the purpose of balloon pulmonary val- vuloplasty. We required two venous accesses for the S. Masutani Á H. Senzaki (&) Department of Pediatric Cardiology, International Medical Center, Saitama Medical University Hospital, Saitama, Japan e-mail: hsenzaki@saitama-med.ac.jp Fig. 1 Case 1. A Schematic diagram showing the path used to advance the guidewire from the vein into the artery. B The end of the loop-tipped guidewire is located in the left femoral vein 123 Pediatr Cardiol (2008) 29:205–206 DOI 10.1007/s00246-007-9035-9