Figure 2.

Transhepatic cardiac catheterisation in patient 12 with hypoplastic left heart syndrome. Top left, percutaneous transhepatic puncture with a 22 gauge needle through the interspace-midaxillary line, midway between the diaphragm and lower margin of the liver after local anaesthesia under fluoroscopic guidance and gently infused contrast medium. Top right, 5 French sheath placed into the low right atrium guided by a previously placed wire. Bottom left (lateral view fluoroscopy), inflated balloon catheter placed in the restricted patent foramen ovale necessitates further gradual balloon dilatation. Bottom right, steel coil inserted through the sheath into the liver parenchyma peripheral to the hepatic vein.