Direct Needle Puncture Research Articles

Cardiac ventriculography: Practical considerations

Summary 1. The procedure of cardiac ventriculography (direct transthoracic needle puncture opacification of the left or right ventricle) is discussed. 2. Its usefulness in the demonstration and quantitation of atrioventricular valvular insufficiencies is described. 3. The demonstration of left ventricular aneurysms, interventricular septal defects and certain lesions of the thoracic aorta by cardiac ventriculography is mentioned. 4. The principal dangers and bazards incident to the procedure are considered.

An Improved Method of Coronary Arteriography

Upon inspection of current mortality tables, even the most phlegmatic must agree that there is a clear and compelling reason for improving our therapeutic approach to coronary occlusive disease. Add to this the untold suffering and disability resulting from coronary occlusion and the argument literally becomes a “clarion call that brooks no denial.” Since coronary insufficiency is a result of vascular narrowing, coronary surgery appears to be the most promising avenue of attack. Although relativelyfew patientsmight have sufficiently localized lesions to justify surgery, even a small proportion of the half million fatal cases each year would represent a worthwhile salvage. However, if coronary surgery is to be rationally applied, there must first be a means for determining which patients are suitable candidates for operation. No method short of actual visualization-either by radiological technics or under direct inspectioncan accomplish this important objective. Thus, the desirability of a safe, easily-applied, and diagnostically-reliable method of preoperatively demonstrating diseased coronary arteries seems clearly established. Historical Reports of incidental as well as intentional radiological demonstrations of the coronary vessels date back at least to 1933, with Rousth#{246}i1 and Reboul and Racine2 in the vanguard. Since that time, there have been numerous reports describing coronary arteriography in experimental animals. It appears that man’s coronary arteries were first demonstrated during life by Radner3 in 1945. The earliest large series of coronary visualizations in man, however, is attributable to J#{246}nsson4 who used retrograde’ thoracic aortography via a catheter inserted into a peripheral artery. Most of the retrograde aortograms in this series were done for the study of congenital cardiovascular abnormalities; coronary visualization was merely incidental. Other workers512 have used various aortographic technics-including retrograde arterialcatheterization,directneedle puncture of the ascending aorta, and transthoracic left ventricular needling-specifically for the purpose of demonstrating the coronary circulation. With each of these methods, successful demonstration of coronary vessels required invariably large and sometimes overwhelming doses of concentrated iodine-containing contrast media in order to counteract dilution effects. Even then, there was no assurance that the contrast medium would flow into one or both coronary arteries in sufficient concentration to pro

Suprasternal Transaortic Coronary Arteriography

Opacification of the coronary arteries has been accomplished by direct needle puncture of the ascending portion of the thoracic aorta via a suprasternal approach and injection of highly-concentrated radiopaque medium. Experience with 35 attempts in 31 patients at such coronary opacification is described. The electrocardiographic observations, the reactions, and the complications incident to the study are discussed. Thirteen of the 31 patients had some type of intrapericardial cardiac surgery subsequent to this procedure, and the surgical observations regarding the status of the coronary arteries are compared with the coronary arteriographic findings.

Visualization of the coronary circulation by occlusion aortography: a practical method.

Our nation's highest death rate gives evidence of the failure of traditional therapeutic methods in arteriosclerotic heart disease. In 1959, the disease will take the lives of over a half-million Americans. The lesion which each year is directly responsible for 400 times as many deaths as poliomyelitis is a localized narrowing confined to the proximal divisions of the left coronary artery. We believe that a direct surgical attack constitutes the most logical approach to this essentially mechanical obstruction to myocardial blood flow. If so, it will be necessary to obtain detailed anatomical information concerning the extent and location of disease in order to select patients for surgery, plan the operative approach, and evaluate the results. This report describes a technic for coronary angiography which has been found to be safe and reliable in the dog. We believe it is ready for application to the study of the diseased coronary arteries of man. In this procedure, a special double-lumen balloon catheter is used to inject a contrast substance into the proximal aorta during a period of brief but total occlusion of the ascending aorta just above the site of injection. There being no alternative, all of the contrast substance enters the coronary arteries, thereby allowing their radiographic visualization with maximum efficiency. Coronary Visualization: Background As far as we have been able to determine, the first in vivo contrast studies of coronary arteries were reported by Peter Rousthöi (1) and, independently, by Reboul and Racine (2). Rousthöi's brief but classic article not only described coronary arteriography but also cardiac ventriculography, thoracic aortography, and aortic valvulography. He successfully employed several technics which were subsequently “discovered” by others, including catheterization of the thoracic aorta via peripheral arteries, catheterization of the left ventricle via the aorta, direct needle puncture of the thoracic aorta, and direct needle puncture of the left ventricle. Thus, by the end of 1933, these workers and others had established experimental or clinical precedent for virtually all of today's contrast cardiovascular technics, including coronary visualization. Search of the Quarterly Cumulative Index Medicus covering 1933 to mid-1955 discloses nineteen papers (3–21) dealing primarily with visualization of the coronary arteries during life. Eight additional articles (22–28A) in recent journals bring the total number of reports to twenty-nine.2 Doubt is cast upon the alleged maternal role of clinical necessity by the rough calculation that for each scientific report on coronary visualization in the United States since 1933 there have been a half-million deaths due to arteriosclerotic heart disease! In his Nov. 30, 1945, report, Stig Radner (4) expressed uncertainty as to whether he had succeeded in his efforts to demonstrate for the first time the coronary arteries in living man.