Central venous access in pediatric patients with complex congenital heart disease may be difficult. Percutaneous transhepatic access offers an alternative for patients with occlusion of traditional central venous sites. We reviewed our experience utilizing transhepatic access in 10 consecutive pediatric cardiology patients for central venous lines, cardiac catheterization and endomyocardial biopsy. We include 5 patients who have had multiple procedures via the transhepatic approach.