Percutaneous Left Ventricular Puncture with Catheterization of the Aorta

Abstract

The technique of percutaneous puncture of the left ventricle for the assessment of patients with aortic stenosis was described by Brock, Milstein, and Ross (1956) and the results in the first 28 cases were analysed by Fleming and Gibson (1957). This procedure has now been carried out in 115 patients at these two hospitals and the technique has been extended to include catheterization of the aorta via the left ventricular needle. This paper describes our experience with catheterization of the aorta by this method in the first 36 attempts. It is desirable to catheterize the aorta for two reasons. First, pressure tracings recorded continuously during the withdrawal of the catheter tip from the aorta to the left ventricle may reveal subvalvar stenosis undietectable by any other method short of surgical exploration (Brock and Fleming, 1956). This is an important consideration in all patients with congenital aortic stenosis and in patients with severe left ventricular hypertrophy due to aortic valve stenosis or to hypertension (Brock, 1957b). Second, the systolic pressure gradient across the aortic valve is calculated more accurately from the aortic pressure pulse than from a peripheral arterial pulse. Although the difference between the central and peripheral pulse contours is usually small in aortic stenosis (Wright, Toscano-Barboza, and Brandenburg, 1956) the variability of this has not yet been fully explored.