Percutaneous Left Ventricular Puncture in the Assessment of Aortic Stenosis

Brock, R. C.; Milstein, B. B.; Ross, Donald N.

doi:10.1136/thx.11.3.163

Cited by 195 publications

(46 citation statements)

References 8 publications

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“…Percutaneous puncture of the left ventricle was carried out by the method of Brock, Milstein and Ross (12) as modified in this laboratory (13). All such tracings were obtained with a 3.5-inch no.…”

Section: Methodsmentioning

confidence: 99%

Studies on the First Derivative of the Ventricular Pressure Pulse in Man

Gleason¹,

Braunwald²

1962

J. Clin. Invest.

382

110

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The rate at which the ventricular pressure rises has been of interest to investigators for many years (1, 2). Wiggers demonstrated that when ventricular end-diastolic filling pressure was elevated by increasing the venous return to the heart or the resistance to ventricular ejection, the rate of rise of ventricular pressure also increased (3). When epinephrine (4) or digitalis (5) was administered the rate of pressure rise increased despite a fall in ventricular end-diastolic pressure. Conversely, when myocardial ischemia was induced, the slope of the ventricular pressure rise decreased in the face of a rising end-diastolic pressure (6). More recently, although further observations have been made in the dog on the determinants of the slope of the ventricular pressure pulse (7-11), there have been no systematic studies of the effects of physiologic stresses, pharmacologic agents, and various types of heart disease on the slope of the ventricular pressure pulse in man. Accurate determinations of the instantaneous rate of ventricular pressure change in intact human subjects have been prevented by the technical limitations imposed by the pressure-recording systems that are usually employed in cardiac catheterization. These systems, which consist of a fluid-filled catheter and an external manometer, have a very limited range in which the frequency response is uniform (usually to less than 15 cycles per second) and they are subject to frequent artifacts related to motion of the catheter within the heart. Such artifacts may be manifest as sudden changes in pressure and will therefore be greatly exaggerated when their first derivative is computed. These difficulties have been largely eliminated by obtaining the ventricular pressure tracings with a catheter that has a high-frequency micromanometer mounted at its tip, or by direct needle puncture of the ventricle. METHODS Percutaneous puncture of the left ventricle was carried out by the method of Brock, Milstein and Ross (12) as modified in this laboratory (13). All such tracings were obtained with a 3.5-inch no. 19 or 20 gage thin-walled needle attached directly to a Statham P23D pressure transducer without intervening tubing. All other studies from either the left or right ventricle were carried out with a Telco intracardiac manometer 1 (14, 15). This instrument consists of a double-lumen catheter, one lu-men of which carries the electrical connection to the micromanometer mounted at the tip, the other serving as a conventional fluid-filled catheter system which is attached to a Statham P23D manometer. The sensitivities of the micromanometer and the external manometer were equalized with an air-pressure calibrating system prior to the introduction of the catheter into the heart. The catheter tip was placed in the right or left ventricle and simultaneous pressure pulses were recorded from the two manometers. The baseline for the micromanometer was made equal to that of the external manometer by superimposing the diastolic portions of the two ventricu-lar pressure pulses...

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Section: Methodsmentioning

confidence: 99%

Studies on the First Derivative of the Ventricular Pressure Pulse in Man

Gleason¹,

Braunwald²

1962

J. Clin. Invest.

382

110

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“…Mitral pansystolic murmurs were audible, and the diagnosis of pure or predominant mitral incompetence was made from the presence of all of the following findings: clinical and radiological evidence of left ventricular enlargement; a left ventricular apical impulse displacement curve (Schneider and Klunhaar, 1961) showing prominent inward movement at the time of the third heart sound, and evidence of stasis in diastole; a third heart sound and diastolic murmur characteristic of incompetence (Nixon and Wooler, 1960;Nixon, 1961a and b); a left atrial stasis wave revealing raised left ventricular end-diastolic pressure and disappearance of the atrio-ventricular pressure gradient (Nixon and Wooler, 1961); and gross distortion of the blue 382 dye (Nixon and Snow, 1962) or ascorbic acid (Nixon et dl., 1963) (Nixon, 1960), and the left ventricle was entered in the text are indicated on this tracing of simultaneously by apical percutaneous puncture (Brock, Milstein, recorded left atrial (LA) and left ventricular (LV) and Ross, 1956 Measurements. An abnormally large left ventricular filling pressure gradient occurred in every cardiac cycle in every patient.…”

Section: Methodsmentioning

confidence: 99%

Left Ventricular Filling Pressure Gradient in Mitral Incompetence

Nixon¹,

Wooler²

1963

Heart

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During the period of ventricular filling the mean pressure gradient across the normal mitral valve measures between 0 and 1 mm. Hg. In mitral stenosis the gradient is pathologically increased by an amount that depends upon the severity of the constriction and upon the nature and quantity of the blood flow through the orifice (Braunwald et al., 1955). While this much is generally accepted, there is little agreement about the findings in mitral incompetence. Most reports suggest that an abnormally large left ventricular filling pressure gradient is a sign of obstruction that should not occur in "pure" mitral incompetence (Braunwald et al., 1955;Moscovitz and Wilder, 1957;Dickens et al., 1957;Marshall and Wood, 1958;Bjork and Malmstrom, 1959; Lancet, 1959;Luisada and Liu, 1959). In mitral incompetence some have recorded a pressure gradient that was "rapidly disappearing", found "only in early diastole", or "small" (Fox et al., 1956;Musser, Bougas, and Goldberg, 1956;Hamer and Dow, 1961). Others have said that the mitral diastolic pressure gradient of incompetence is indistinguishable from that of stenosis (Marshall, Connolly, and Wood, 1957;Dexter et al., 1957). Davila recognized the occasional occurrence of a large left ventricular filling pressure gradient in severe mitral incompetence, and suggested that in this condition a mitral orifice of normal size might be too small to carry without hindrance the greatly excessive diastolic blood flow (Davila, 1958;Davila et al., 1958).In this clinic the left atrial and ventricular pressure pulses were measured simultaneously at cardiac catheterization in five patients who were subsequently treated surgically for mitral incompetence. Abnormally large left ventricular filling pressure gradients were found. In some patients the atrio-ventricular ring was dilated, the mitral orifice was larger than normal, the cusps did not adhere to each other, and no element of organic obstruction was present.The purpose of this communication is to describe the left ventricular filling pressure gradients that were recorded, and to consider the clinical implications of their presence. SUBJECTS AND METHODSThe left atrial and the left ventricular pressures were measured simultaneously during cardiac catheterization in five women shortly before their surgical treatment. They were considered to be disabled by atrial fibrillation and chronic rheumatic mitral valvular disease, and to be free from congestive heart failure and from aortic valvular, hypertensive, and ischemic heart disease. Pulmonary hypertension was present.Mitral pansystolic murmurs were audible, and the diagnosis of pure or predominant mitral incompetence was made from the presence of all of the following findings: clinical and radiological evidence of left ventricular enlargement; a left ventricular apical impulse displacement curve (Schneider and Klunhaar, 1961) showing prominent inward movement at the time of the third heart sound, and evidence of stasis in diastole; a third heart sound and diastolic murmur characteristic of in...

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“…Several methods have been developed for catheterization of the left heart, such as retrograde aortic catheterization (Zimmerman et al, 1950), transbronchial (Morrow et al, 1957), and suprasternal (Radner, 1954) puncture of the left atrium, and direct transthoracic puncture of the left atrium (Bjork et al, 1953) and ventricle (Brock et al, 1956). With the exception of the retrograde aortic catheterization technique, these methods all had diagnostic limitations, were associated with technical difficulties, and were potentially dangerous as well as painful (Bagger et Failure to enter the left atrium occurred in 8.6% of our series, which is comparable with the failure rate of up to 10% reported by other authors (Brockenbrough et al, 1962;Enghoff and Cullhed, 1971;Lew et al, 1983).…”

Section: Discussionmentioning

confidence: 99%

Transseptal left heart catheterization: A review of 278 studies

B‐Lundqvist

Olsson

Varnauskas

1986

Clinical Cardiology

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Summary:In our laboratory, we performed 278 transseptal left heart catheterizations in adult patients over a period of 13 years. The left atrium was entered in 91.4% of the intended left heart catheterizations. Of 252 attempts, the left ventricle was entered in 96.1 % . Major complications were aortic puncture (0.7%), pericardial puncture/suspected tamponade (3.2 %), systemic arterial embolism (1.1 %), and suspected perforation of the inferior vena cava (0.4%). There were no deaths. Although less frequently performed during the last decade, the transseptal catheterization technique has a complication rate of the same magnitude as during periods when this method was more commonly applied.

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Percutaneous Left Ventricular Puncture in the Assessment of Aortic Stenosis

Cited by 195 publications

References 8 publications

Studies on the First Derivative of the Ventricular Pressure Pulse in Man

Studies on the First Derivative of the Ventricular Pressure Pulse in Man

Left Ventricular Filling Pressure Gradient in Mitral Incompetence

Transseptal left heart catheterization: A review of 278 studies

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