Cardiac Puncture Catheterization

Experience in 80 Patients

¹ Minneapolis, Minnesota

A new approach for heart catheterization combined with angiography has been developed experimentally and applied in 80 patients.

Basically, the method consists of insertion of a suitable-sized plastic catheter over a needle through the chest wall into the left or right ventricle and then assessing the adjunct valves. From each of the sites entered by the catheter, blood samples, pressure recordings, or angiography may be readily done.

Forty-two of the patients studied had congenital heart disease, 37 acquired, and one was normal. Seventy per cent of the patients had aortic stenosis (isolated or combined) in which the "retrograde" approach of the "transatrial" approach has usually failed in the past.

Each of the patients was subjected to a left heart puncture and five to both left and right. In 69 of the patients, the procedure was of diagnostic value and in 11 for postoperative follow-up.

The aortic valve was assessed in 100 per cent of the cases and the mitral valve in 83 per cent of the attempted cases.

One death in a patient with a single ventricle and transposition was related to the procedure and was due to an intramural dye injection.

Other less significant complications occurred, and suggestions for their prevention or treatment have been made. Particular reference has been made to the strength and design of the flexible guide utilized.

Selective angiography (usually left ventriculography and aortography) of good quality was obtained routinely and a variety of uncommon conditions were accurately diagnosed. This included lesions such as left ventricular-right atrial canal, aorticoleft ventricular tunnel, sub-aortic stenosis of congenital or acquired origin, and others. Many of these subsequently had been operated, the diagnosis confirmed, and the lesion repaired.

Indications for cardiac puncture catheterization have been suggested with a strong recommendation as the procedure of choice in aortic stenosis. Postoperative left heart studies are particularly facilitated by this method.

It has certainly been most gratifying to witness the "puncture catheterization" as described become an integral part of the daily routine work-up among the large variety of patients with cardiovascular lesions in our Department of Surgery.