Extended Suprasternal Puncture

Abstract

The technique of suprasternal puncture of the left atrium and great vessels was first described by Radner nearly ten years ago in a series of publications in which he outlined the successive stages in its development (Radner, 1953(Radner, , 1954a(Radner, , b, and c, 1955. He had been using the suprasternal approach for aortic puncture and had found that the needle would occasionally pass behind the aorta and enter the left atrium. During the further development of left atrial puncture he found that, in 3 of his first 6 cases, the needle passed through the pulmonary artery before entering the left atrium. Impressed by the simplicity and safety of these procedures, he subsequently described the technique of "extended suprasternal puncture" in which the aorta, pulmonary artery, and left atrium are punctured successively.In this paper we propose to describe our experience for the past four years with suprasternal puncture, either alone or in combination with other methods of left heart catheterization. We shall also describe the instrumentation that has been developed to allow the maximum information to be obtained from these investigations.SUBJECTS AND METHODS Suprasternal puncture has been carried out in 52 patients whose ages ranged from 8 to 65. In 50 there was evidence of mitral valve disease either alone or in association with aortic valve disease: in these patients the purpose of the procedure was to determine the relative significance of the valvular lesions. In addition, one patient with cor pulmonale was investigated to determine the pulmonary arterial pressure and, in a case of pure aortic stenosis, suprasternal aortic puncture was carried out together with percutaneous left ventricular puncture.

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

“…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;Russell, Carroll, and Hood, 1964;McIntosh, Whalen, Hernandez, Morris, and Miller, 1961;Adrouny, Sutherland, Griswold, and Ritzmann, 1963).…”