Reappraisal of the Posterior Percutaneous Technique of Left Heart Catheterization

¹ Assistant Professor of Medicine, University of Illinois College of Medicine; Assistant Director, Department of Adult Cardiology, Cook County Hospital, Chicago, Illinois
² Department of Adult Cardiology, Cook County Hospital, Chicago, Illinois
³ Professor of Medicine, University of Illinois College of Medicine; Director, Section of Adult Cardiology, University of Illinois Research and Educational Hospitals; Associate Director of the Department of Adult Cardiology, Cook County Hospital, Chicago, Illinois
⁴ Professor of Medicine, Loyola University Stritch School of Medicine; Director of the Department of Adult Cardiology, Cook County Hospital, Chicago, Illinois

In 207 consecutive patients complications associated with posterior percutaneous cardiac catheterization are described. The posterior percutaneous, transseptal and anterior percutaneous methods of catheterization of the left heart chambers and their reported frequencies of complications are compared. Perforations of the heart or great vessels resulted in 52 percent of all mortality and were most prevalent (1.98 percent) with the anterior percutaneous method. Embolism although small in overall frequency accounted for 25 percent of all the mortality. Pulmonary complications although frequent (2.49 percent) with the posterior percutaneous approach resulted in almost no mortality and practically never required major surgical intervention. There is slightly more morbidity with the posterior approach to a large extent caused by pulmonary complications which appear to have become less frequent with TV image intensification. The anterior percutaneous method has the highest mortality from perforation of the heart and allows for the least amount of time within the left ventricular cavity to study hemodynamic events. There is an approximate 3 percent rate of failure to enter the left atrium and left ventricle via the transseptal and the anterior percutaneous routes, respectively. It is concluded that the posterior approach is technically the simplest and the transseptal the most complex method. We find the posterior percutaneous approach a useful alternative to transseptal catheterization of the left atrium and a relatively safe and easy method for physicians in training to learn.