A new technic, utilizing a hydrogen-sensitive, platinum-tipped wire electrode introduced percutaneously via a No. 18 Cournand needle into the brachial vein and flow-directed into the right heart chambers and pulmonary artery, has greatly simplified the detection of left to right intracardiac shunts. The position of the electrode is identified by intracavitary electrocardiographic monitoring. Electrical potential, created by contact of inhaled hydrogen with the platinum tip, produces characteristic electrocardiographic deflections when left to right shunts are present. Two hundred and four catheterizations in 182 patients screened for possible left to right shunts yielded 86 positive, 115 negative and 3 equivocal shunt curves. Fifty-three instances have been confirmed by conventional cardiac catheterization technics or surgery, or by both. No definite false positive curves were obtained other than from the easily identified pulmonary wedge position. In 5 patients false negative curves were obtained from the proper chamber; however, in each instance positive curves were recorded from one chamber distally. This technic can be performed as an outpatient procedure in 15 to 30 minutes without discomfort except for venipuncture. Minor complications observed were brief supraventricular arrhythmia (3), multiple extrasystoles (2), transient difficulty in electrode dislodgment (2), and intracavitary knotting (2). No major complications have occurred. Caution is expressed regarding proper grounding of all electrical equipment to prevent electrically induced ventricular fibrillation. The potential hazard of a knot in the wire electrode embracing a papillary muscle or chorda tendinea suggests the need of ready access to an experienced cardiac surgeon. The procedure presents a simple, reliable and reasonably safe method for determing left to right shunts, both preoperatively and postoperatively, and often obviates the need for major catheterization.
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