Complications in 1,056 investigations of the left side of the heart

Christiansen, I; Wennevold, A

doi:10.1016/0002-8703(66)90309-7

Cited by 19 publications

(20 citation statements)

References 17 publications

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“…Fortunately, serious morbidity or mortality after needle puncture of the LA free wall or aorta is uncommon if the sheath and dilator are not advanced. Overall, serious complications from TS catheterization are Յ1% (1,17,18). After successful puncture of the atrial septum, the patient should be immediately anticoagulated (heparin or direct thrombin antagonist) to minimize the risk of thromboembolism.…”

Section: Puncture Of the Fossa Ovalismentioning

confidence: 99%

“…Various direct methods, such as transbronchial, supraclavicular (1), and transseptal (TS) puncture (2)(3)(4), were developed in the 1950s to measure LA pressure. Despite acceptable feasibility and safety (1,2,5), these methods were replaced by indirect measurements of LA pressure with a Swan-Ganz catheter. Right heart catheterization with a balloon wedge catheter replaced TS left heart catheterization not only because of ease and safety, but because many hemodynamic parameters could be measured with a single catheter.…”

mentioning

confidence: 99%

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Emerging Applications for Transseptal Left Heart Catheterization

Babaliaros

Green

Lerakis

et al. 2008

Journal of the American College of Cardiology

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Transseptal (TS) catheterization was introduced in 1959 as a strategy to directly measure left atrial (LA) pressure. Despite acceptable feasibility and safety, TS catheterization has been replaced by indirect measurements of LA pressure using the Swan-Ganz catheter. Today, TS puncture is rarely performed for diagnostic purposes but continues to be performed for procedures such as balloon mitral valvuloplasty, antegrade balloon aortic valvuloplasty, and ablation of arrhythmias in the LA. Thus, the "art" of TS puncture has been lost, except in centers that perform these procedures with regularity. Recently, there has been a renewed interest in the TS technique because of emerging therapeutic procedures for structural heart disease and atrial fibrillation ablation. Invasive cardiologists will have to refamiliarize themselves with the TS technique, newer TS devices, and advanced ultrasound imaging for guidance of the procedure.

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Section: Puncture Of the Fossa Ovalismentioning

confidence: 99%

mentioning

confidence: 99%

Emerging Applications for Transseptal Left Heart Catheterization

Babaliaros

Green

Lerakis

et al. 2008

Journal of the American College of Cardiology

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“…The risk of cardiac perforation and tamponade during cardiac catheterization is generally anticipated to be low, 0.04%-0.6% [20,21]. A considerably higher incidence has been recorded in a series of transsepta1 catheterizations [22]. With regard to the complications related to endomyocardial biopsy, Sekiguchi et al found the incidence of complications about the same as in ordinary cardiac catheterization, based on a world-wide questionnaire study [23].…”

Section: Considerations Regarding the Prevention Of Biopsy Complicationsmentioning

confidence: 99%

Endomyocardial biopsy with a modified bioptome introducer sheath: Focus on diagnostic yield and prevention of complications

Mortensen

Baandrup

1987

Cathet. Cardiovasc. Diagn.

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With a focus directed on the potential diagnostic yield of tissue biopsy in suspected myocardial disease, transvascular endomyocardial biopsies were carried out prospectively in 130 patients. In 149 out of 153 consecutive procedures, where the number of associated major complications was less than 1%, King's bioptome and a specially designed radiopaque long introducer catheter were used. The rather thickwalled sheath had a conical tip which facilitated percutaneous entry and a preshaped distal bending which was particularly useful in the right ventricle for obtaining a steady and safe position in the direction of the interventricular septum. With respect to the histopathological information from an average of 4.2 biopsies per patient, a high clinical yield was gained in 28% of the patients, in the form of specific diagnoses and/or findings influencing subsequent therapy, and useful diagnostic information was gleaned from a further 53%. Thus, the procedure appears safe as a part of routine cardiac catheterization, and biopsy may contribute to a more accurate and clinically relevant classification of a substantial number of patients with suspected myocardial disease.

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mentioning

confidence: 99%

“…Attempts at complete catheterization of the left heart by transseptal and retrograde routes are not always completely informative nor entirely free from complications (Crowley and Parkin, 1956;Kavanagh-Gray and Drake, 1958;Aldridge, 1964;Samet, Bernstein, and Levine, 1965;Christiansen and Wennevold, 1966), and further alternative means of obtaining haemodynamic information from the left side of the heart seem invaluable.…”

mentioning

confidence: 99%

Left heart catheterization by direct ventricular puncture.

Semple¹,

McGuinness²,

Gardner³

1968

Heart

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Attempts at complete catheterization of the left heart by transseptal and retrograde routes are not always completely informative nor entirely free from complications (Crowley and Parkin, 1956; KavanaghGray and Drake, 1958;Aldridge, 1964;Samet, Bernstein, and Levine, 1965;Christiansen and Wennevold, 1966) TECHNIQUEThe patient, premedicated with pethidine, lies supine and the apex beat is located by palpation. The site and direction of entry at the apex is determined by screening a forceps tip or needle. This site is anaesthetized down to the pericardium, and after a minute or two, a small skin puncture hole is made with the tip of a scalpel.A 19-gauge needle, 20 cm. (8 in.) long, over which an 18-gauge teflon catheter fits snugly, is connected by a length of tubing to the pressure transducer. The catheter with needle trocar is now advanced through the skin and subcutaneous tissues, pointing in the long axis of the heart towards the second right chondrosternal junction until the tip is seen and felt to touch the apex of the heart. It is then inserted rapidly through the ventricular wall, entry into the left ventricle being confirmed immediately by the appearance of a left ventricular pressure tracing on No. 6 or 7 Gensini catheter is passed into the heart. When the catheter tip is placed satisfactorily in the appropriate chamber, angiocardiography is carried out in the usual way. If attempted catheterization of the left atrium has been unsuccessful, a further attempt can be made using the stiffer catheter. In the earliest patients studied, the catheter was stitched to the chest wall, since Levy and Lillehei had noted recoil of the catheter at the time of pressure injection, but later we found this to be unnecessary with the Gensini catheter.After the procedures have been completed the catheter is removed from the heart and pressure maintained over the puncture for two or three minutes. The whole undertaking usually takes about 20 to 30 minutes, but if no angiography is required, pressure records may be obtained in a matter of 10 to 15 minutes. SUBJECTSStudies were made on 22 dogs in an attempt to evaluate the method. Special interest was taken in the amount of bleeding into the pericardium and pleura, ease of entry into the desired areas, damage to the lung, and the incidence of serious arrhythmias.Eighteen dogs were divided into three groups of six.The first group had one clean ventricular puncture and the full procedure carried out using a No. 6 Gensini catheter as described above. The second group had three cardiac punctures and then the full procedure carried out once using a No. 6 Gensini catheter, since it was felt that the effect of several attempts at this procedure should be known. The third group had one cardiac 402

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Complications in 1,056 investigations of the left side of the heart

Cited by 19 publications

References 17 publications

Emerging Applications for Transseptal Left Heart Catheterization

Emerging Applications for Transseptal Left Heart Catheterization

Endomyocardial biopsy with a modified bioptome introducer sheath: Focus on diagnostic yield and prevention of complications

Left heart catheterization by direct ventricular puncture.

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