New technique for retrograde left heart catheterization in aortic stenosis.

Abstract

Retrograde catheterization of the left ventricle in patients with aortic stenosis is frequently difficult and occasionally impossible. We have developed a new technique to facilitate this problem. A standard #8 "pigtail" catheter is preformed with a 145 degrees angle 7 cm from the catheter tip. With this catheter in the ascending aorta, the preformed angle lifts the catheter tip leftward and superiorly, allowing a straight guidewire a direct approach to the orifice of the stenotic aortic valve. Utilizing this technique, we were able to cross the stenotic aortic valve in 26-29 consecutive patients with isolated aortic stenosis (mean gradient +/- 0.22 cm2, mean fluoroscopy time for crossing: 32 +/- 40 seconds). The 145 degree angle also lifts the catheter off the posterior wall of the left ventricle and allows a more parallel alignment of the catheter with the long axis of the left ventricle, leading to a more stable position with less ventricular dysrhythmias during angiography. Thus a preformed angle in the "pigtail" catheter facilitates crossing of the stenotic aortic valve and produces a more stable position in the left ventricle.