T HE LEFT VENTRICLE may be catheterized from the aorta,1-3 from the left atrium by several routes,46 or may be directly punctured. Since 1958 we have performed left ventricular puncture in 142 cases for pressure measurements and contrast injection. It is the aim of this paper to report our complications together with a review of those reported by others.Material and Methods Our cases were 6 months to 56 years old, most between 30 and 40 years of age. The diagnoses are presented in table 1. The main indications for the procedure were aortic stenosis or mitral insufficiency, and our results with it were recently reported.7-9The investigation is performed with the patient in the fasting state, under penicillin prophylaxis with blood and necessary equipment for cardiac resuscitation in readiness. In adult patients general anesthesia is not used, only premedication with morphine and scopolamine. The puncture is performed by a thoracic surgeon in the presence of a cardiologist, an anesthesiologist, and a radiologist. We use the intercostal method of Brock et al. 10' 11 We only wish to stress that the needle used has a blunt end and a sharp mandrin. When the ventricular cavity is reached, the needle is locked by a screw so that it cannot be introduced farther. An electrocardiogram is continually monitored on a two-beam cathode-ray oscilloscope. The pressure curves from the left ventricle and a peripheral artery are recorded. The ventricular curve must be free and undamped up to the moment of contrast injection and during slight changes in the position of the needle, in order to avoid intramyocardial deposition of contrast medium. With an automatic pressure syringe we then inject 1 to 1.2 ml. per Kg. of body weight of 76 per cent Urografin, with a speed of about From the Department of Thoracic Surgery (Head:
The anatomical relationships between the ventricular system and the cranial cavity in children have received some attention. The relatively high position of the third ventricle above the sella turcica and its progressive downward displacement during the first ten years of life have been described and similarly the relatively high position of the fourth ventricle above the foramen magnum has also been recorded (ROBERTSON).The aim of the present investigation has been to study the relations during the period of growth between certain anatomical structures within the ventricular system and landmarks on the base of and within the skull.Material. All unequivocally pathologic cases (intracranial expansion, hydrocephalus, dilatation of one lateral ventricle, and malformations) were first excluded from the total material of encephalographies in children under 15 years of age. Cases with a large amount of subdural air were also not considered suitable. This left 164 negative encephalographies as a basis for the study. The material included a few cases with relatively wide convexity grooves and rather wide lateral ven-
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