A potential hazard of the transseptal left atrial catheterization technic∗

McIntosh, Henry D.; Whalen, Robert E.; Hernández, Rafael Rivas; Morris, James J.; Miller, David

doi:10.1016/0002-9149(61)90247-8

Cited by 17 publications

(3 citation statements)

References 5 publications

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“…Over 1100 catheterizations of the left heart via the transseptal route have been reported (Cope, 1959;Singleton and Scherlis, 1960;Nixon, 1960;Steinhart and Endrys, 1960;Fisher, Logsdon, and McCaffrey, 1960;Bevegard et al, 1960;McGaff et al, 1961;McGuire et al, 1961;Gorlin et al, 1961;Soulie et al, 1961;Reale, 1961;McIntosh et al, 1961;Iliescu et al, 1961;Beuren and Apitz, 1962a;Brockenbrough, Braunwald, and Ross, 1962). This expenrence cannot be handled as a continuous series with reliable percentage incidence because the unpublished experience may or may not be as favourable.…”

Section: Discussionmentioning

confidence: 99%

Transseptal Left Heart Catheterization

Bl¹,

We²

1964

Heart

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Left heart catheterization by puncture of the atrial septum was introduced by Manfredi (1956) and elaborated by Ross (1959). We have investigated 65 patients by this method and present our results with particular reference to its safety and effectiveness.SUBJECTS AND METHODThe majority of the patients had rheumatic heart disease ( Table I). The age range was 9 to 67 years and the distribution is shown in Table II. There were three patients under 17 years of age. The size of the left atrium was graded on X-ray (penetrated postero-anterior, right lateral, and right anterior oblique views with barium in the cesophagus) and was found to be normal in 11, slightly enlarged in 23, moderately enlarged in 29, and aneurysmal in 2 patients.The basic technique of transseptal left atrial puncture used was that described by Ross, Braunwald, and Morrow (1960). Briefly, this consists of introducing a 595 cm. long catheter into the right atrium from the right saphenous vein, threading the 61 cm. transseptal needle (Fig. 1) through the catheter and puncturing the septum in the region of the fossa ovalis with the needle. It has not always been found possible to make contact with the atrial septum in the lower half of the right atrial shadow as advised by Ross since a small left atrium frequently lies higher. When this is the case it is considered especially important to maintain the 450 posterior slant of the needle at puncture since the aorta is at the same level but anterior to the left atrium.The entire procedure is done under fluoroscopic control, and blood samples and pressure pulses are taken through the needle immediately before and after the puncture to confirm the position of its tip.When, in ten of the earlier cases of the series, information was required from the left ventricle as well as the atrium, an attempt was made to obtain it by passing a thin polythene tube through the needle once its tip was lying in the left atrium . This procedure was unsatisfactory in our laboratory and was abandoned in favour of advancing the large catheter over the needle after the tip of the needle has been introduced into the atrium. The procedure evolved in our laboratory whereby the needle is held stationary while the catheter is advanced differs slightly from that described by Brockenbrough and Braunwald (1960) and Gorlin et al. (1961) in which the needle and catheter are advanced together for a short distance with the needle point protruding before the catheter is further advanced over the needle. Once the catheter is in the left atrium the needle is withdrawn to the point of puncture and the catheter advanced into the ventricle. The needle is then removed and all the pressure measurements under rest and exercise conditions and the blood samples required in the individual case are obtained, and contrast injection is performed if indicated.When right heart catheterization was indicated it was performed through the same vein either after the left heart catheterization (40 patients) or simultaneous with it (6 patients). The bleeding tha...

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Section: Discussionmentioning

confidence: 99%

Transseptal Left Heart Catheterization

Bl¹,

We²

1964

Heart

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“…Perforation of the heart wall was reported in 9 cases by Adrouny et al (1963); 3 cases by Libanoff and Silver (1965), and a similar accident which ended fatally is described by Russell, Carroll, and Hood (1964). Penetration of the catheter wall by the needle is mentioned by McIntosh et al (1961) and may also occur with the original needle used by Ross if the specially made woven introducing catheter is not used (Macdonald and Miller, 1962). In one case described by Parker, West, and Fay (1964) the narrow tip of the needle became detached and was left transfixing the atrial septum.…”

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Catheterization of the left atrium by Ross needle and Seldinger wire techniques.

Vérel¹

1967

Heart

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“…In the past two years, however, several authors have reported series with an acceptably small incidence of complications (Willman, Hanlon, Symbas, Kelly, and Mudd, 1964;Hansen, Fabricius, Pedersen, and Sand0e, 1962;Blackburn and Fleming, 1964). Certainly the occurrence of serious incidents is less than that reported after alternative methods of left heart catheterization (Susmano and Carleton, 1964;Russell, Carroll, and Hood, 1964;McIntosh, Whalen, Hernandez, Morris, and Miller, 1961;Adrouny, Sutherland, Griswold, and Ritzmann, 1963). In our experience, two precautions require emphasis-the needles should not be larger than No.…”

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Percutaneous left heart pressure measurements: an aid in the selection of patients for surgery.

Bain¹,

Thomson²,

Mackey³

1966

Thorax

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The selection of patients with mitral and aortic valve disease for surgery can usually be made from the clinical, radiological, and electrocardiographic data. In a significantly large proportion of cases, however, more direct measurements of the haemodynamic effects of the valve lesion add valuable information. This communication concerns the use of percutaneous needle puncture of the chambers of the left heart, the aorta, and the pulmonary artery in the assessment of some cases of valvular disease. It is based on an analysis of more than 300 diagnostic procedures.The suprasternal route described by Radner (1955) has been used to reach the aorta, pulmonary artery, and left atrium, and that described by Brock, Milstein, and Ross (1956) (Radner, 1955;Brock et al., 1956). It has been our practice to employ general anaesthesia on the grounds that this makes the procedure more acceptable to the patient as well as providing a steadier haemodynamic state. The measurements can be made in about 10 minutes, and the quality of the pressure records is strikingly superior to that obtained through a catheter.The nmethod has not been widely adopted until recently, presumably because of the potential risks associated with blind needle puncture of the great vessels and heart. In the past two years, however, several authors have reported series with an acceptably small incidence of complications (Willman, Hanlon, Symbas, Kelly, and Mudd, 1964; Hansen, Fabricius, Pedersen, and Sand0e, 1962;Blackburn and Fleming, 1964). Certainly the occurrence of serious incidents is less than that reported after alternative methods of left heart catheterization (Susmano and Carleton, 1964;

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A potential hazard of the transseptal left atrial catheterization technic∗

Cited by 17 publications

References 5 publications

Transseptal Left Heart Catheterization

Transseptal Left Heart Catheterization

Catheterization of the left atrium by Ross needle and Seldinger wire techniques.

Percutaneous left heart pressure measurements: an aid in the selection of patients for surgery.

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