Left heart catheterization with selective left atrial and ventricular angiocardiography in the diagnosis of mitral and aortic valvular disease

Björk, Viking Olov; Lodin, Herman

doi:10.1016/s0033-0620(59)80021-9

“…Left ventricular puncture was described by Brock, Milstein, and Ross (1956), and its use was extended by passing a fine catheter through the needle into the aorta (Fleming et al, 1958); this was possible in 78 per cent of cases. A further refinement is the use of a bevelled "teflon" catheter introduced over the needle, for catheterization of the aorta after the needle is withdrawn (Levy et al, 1962).…”

Section: Resultsmentioning

confidence: 99%

“…Left ventricular puncture is a straightforward technique that can be quickly accomplished and is nearly always successful. Unfortunately there is a significant risk of hlmopericardium, and a mortality of about 2 per cent is reported by Fleming et al (1958) and Bjork and Lodin (1959).…”

Section: Resultsmentioning

confidence: 99%

Retrograde Left Ventricular Catheterization and Cardioangiography in Aortic Stenosis

Gray¹,

Joshipura²

1964

Heart

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It is often difficult to judge the severity of aortic stenosis by clinical methods and to distinguish between the different varieties that occur. The size of the orifice can be calculated by measuring aortic and left ventricular pressures and simultaneously estimating the cardiac output. The site of the obstruction may be demonstrated by recording the changes in pressure as a catheter passes from the left ventricle to the aorta. Cardioangiography after injection of contrast medium into the left atrium or ventricle can also demonstrate visibly the site and nature of the obstruction.Retrograde catheterization of the left ventricle from a peripheral artery, with injection of contrast medium into the left ventricle, is a simple means of obtaining all the required information. We describe our results in a series of patients with aortic stenosis investigated in this way. SUBJECTS AND METHODSTwenty-five patients with signs of significant aortic stenosis were investigated. The aortic lesion was congenital in 14 and rheumatic in 7, all of whom had associated lesions of the mitral valve. One patient had hypertrophic muscular sub-aortic stenosis, and the letiology in three patients with aortic valve stenosis was uncertain (Table).Right cardiac catheterization was first carried out and the catheter left with its tip in the pulmonary artery. The right brachial artery or one of its branches was then catheterized using a thin-walled nylon catheter (N.I.H. pattern Nos. 6-9). The passage of the catheter was followed radiologically using an image intensifier, and the pressure was monitored on an oscilloscope which immediately showed when the ventricle was entered. The catheter was changed for one of different shape and size if there was difficulty in passing it through the orifice of the aortic valve. As soon as the left ventricle was catheterized the oxygen consumption was measured and the cardiac output estimated by the Fick principle.

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“…Transseptal left heart catheterization appears to be safer than posterior percutaneous left atrial puncture and anterior percutaneous left ventricular puncture. Furthermore, initial experience of about 120 cases (Steinhart and Endrys, 1960;Braunwald et al, 1962;Beuren and Apitz, 1962b;Paulin and Varnauskas, 1962;Macdonald and Miller, 1962) (Bagger, Bj6rk, and Malstrom, 1957) and by the anterior left ventricular puncture method (Bjork and Lodin, 1959). The transseptal technique may, on the other hand, carry a slightly higher risk than bronchoscopic left atrial puncture which has been shown to be safe over a large series (Morrow, Braunwald, and Ross, 1960) The transseptal method of left heart catheterization as modified has the advantage of allowing access to all four chambers of the heart through a single vein in a reasonably high percentage of cases.…”

Section: Discussionmentioning

confidence: 99%

Transseptal Left Heart Catheterization

Rosenberg¹

2005

Cardiac Catheterization in Congenital Heart Disease: Pediatric and Adult

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Left heart catheterization by puncture of the atrial septum was introduced by Manfredi (1956) and elaborated by Ross (1959). We have investigated 65 patients by this method and present our results with particular reference to its safety and effectiveness.SUBJECTS AND METHODThe majority of the patients had rheumatic heart disease ( Table I). The age range was 9 to 67 years and the distribution is shown in Table II. There were three patients under 17 years of age. The size of the left atrium was graded on X-ray (penetrated postero-anterior, right lateral, and right anterior oblique views with barium in the cesophagus) and was found to be normal in 11, slightly enlarged in 23, moderately enlarged in 29, and aneurysmal in 2 patients.The basic technique of transseptal left atrial puncture used was that described by Ross, Braunwald, and Morrow (1960). Briefly, this consists of introducing a 595 cm. long catheter into the right atrium from the right saphenous vein, threading the 61 cm. transseptal needle (Fig. 1) through the catheter and puncturing the septum in the region of the fossa ovalis with the needle. It has not always been found possible to make contact with the atrial septum in the lower half of the right atrial shadow as advised by Ross since a small left atrium frequently lies higher. When this is the case it is considered especially important to maintain the 450 posterior slant of the needle at puncture since the aorta is at the same level but anterior to the left atrium.The entire procedure is done under fluoroscopic control, and blood samples and pressure pulses are taken through the needle immediately before and after the puncture to confirm the position of its tip.When, in ten of the earlier cases of the series, information was required from the left ventricle as well as the atrium, an attempt was made to obtain it by passing a thin polythene tube through the needle once its tip was lying in the left atrium . This procedure was unsatisfactory in our laboratory and was abandoned in favour of advancing the large catheter over the needle after the tip of the needle has been introduced into the atrium. The procedure evolved in our laboratory whereby the needle is held stationary while the catheter is advanced differs slightly from that described by Brockenbrough and Braunwald (1960) and Gorlin et al. (1961) in which the needle and catheter are advanced together for a short distance with the needle point protruding before the catheter is further advanced over the needle. Once the catheter is in the left atrium the needle is withdrawn to the point of puncture and the catheter advanced into the ventricle. The needle is then removed and all the pressure measurements under rest and exercise conditions and the blood samples required in the individual case are obtained, and contrast injection is performed if indicated.When right heart catheterization was indicated it was performed through the same vein either after the left heart catheterization (40 patients) or simultaneous with it (6 patients). The bleeding tha...

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“…Transseptal left heart catheterization appears to be safer than posterior percutaneous left atrial puncture and anterior percutaneous left ventricular puncture. Furthermore, initial experience of about 120 cases (Steinhart and Endrys, 1960;Braunwald et al, 1962;Beuren and Apitz, 1962b;Paulin and Varnauskas, 1962;Macdonald and Miller, 1962) suggests that selective left angiography by the transseptal technique does not carry a greatly increased risk and this is to be compared with the high risk of angiography by the posterior percutaneous method (Bagger, Bj6rk, and Malstrom, 1957) and by the anterior left ventricular puncture method (Bjork and Lodin, 1959). The transseptal technique may, on the other hand, carry a slightly higher risk than bronchoscopic left atrial puncture which has been shown to be safe over a large series (Morrow, Braunwald, and Ross, 1960), but in our experience the left ventricle is more reliably entered by the modified transseptal method and, in addition, the patient is in a more basal condition.…”

Section: Discussionmentioning

confidence: 99%

Transseptal Left Heart Catheterization

Bl¹,

We²

1964

Heart

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Left heart catheterization by puncture of the atrial septum was introduced by Manfredi (1956) and elaborated by Ross (1959). We have investigated 65 patients by this method and present our results with particular reference to its safety and effectiveness.SUBJECTS AND METHODThe majority of the patients had rheumatic heart disease ( Table I). The age range was 9 to 67 years and the distribution is shown in Table II. There were three patients under 17 years of age. The size of the left atrium was graded on X-ray (penetrated postero-anterior, right lateral, and right anterior oblique views with barium in the cesophagus) and was found to be normal in 11, slightly enlarged in 23, moderately enlarged in 29, and aneurysmal in 2 patients.The basic technique of transseptal left atrial puncture used was that described by Ross, Braunwald, and Morrow (1960). Briefly, this consists of introducing a 595 cm. long catheter into the right atrium from the right saphenous vein, threading the 61 cm. transseptal needle (Fig. 1) through the catheter and puncturing the septum in the region of the fossa ovalis with the needle. It has not always been found possible to make contact with the atrial septum in the lower half of the right atrial shadow as advised by Ross since a small left atrium frequently lies higher. When this is the case it is considered especially important to maintain the 450 posterior slant of the needle at puncture since the aorta is at the same level but anterior to the left atrium.The entire procedure is done under fluoroscopic control, and blood samples and pressure pulses are taken through the needle immediately before and after the puncture to confirm the position of its tip.When, in ten of the earlier cases of the series, information was required from the left ventricle as well as the atrium, an attempt was made to obtain it by passing a thin polythene tube through the needle once its tip was lying in the left atrium . This procedure was unsatisfactory in our laboratory and was abandoned in favour of advancing the large catheter over the needle after the tip of the needle has been introduced into the atrium. The procedure evolved in our laboratory whereby the needle is held stationary while the catheter is advanced differs slightly from that described by Brockenbrough and Braunwald (1960) and Gorlin et al. (1961) in which the needle and catheter are advanced together for a short distance with the needle point protruding before the catheter is further advanced over the needle. Once the catheter is in the left atrium the needle is withdrawn to the point of puncture and the catheter advanced into the ventricle. The needle is then removed and all the pressure measurements under rest and exercise conditions and the blood samples required in the individual case are obtained, and contrast injection is performed if indicated.When right heart catheterization was indicated it was performed through the same vein either after the left heart catheterization (40 patients) or simultaneous with it (6 patients). The bleeding tha...

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Left heart catheterization with selective left atrial and ventricular angiocardiography in the diagnosis of mitral and aortic valvular disease

Cited by 37 publications

References 18 publications

Retrograde Left Ventricular Catheterization and Cardioangiography in Aortic Stenosis

Retrograde Left Ventricular Catheterization and Cardioangiography in Aortic Stenosis

Transseptal Left Heart Catheterization

Transseptal Left Heart Catheterization

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