Left heart catheterization with special reference to the transseptal method.

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Abstract
Left heart catheterization was performed in 508 patients during a period of 6-yr. Needle puncture of the atrial septum was employed in every case and was supplemented by percutaneous catheterization of the aorta and/or percutaneous left ventricular puncture where necessary. The important factors relating to the safety of the techniques, and the complications, are described in detail. The evidence suggests that the Ross technique may be considered safe enough for use outside thoracic surgical centers when diagnosis requires entry into the left atrium. This is the method of choice when the left ventricular pressure pulse is required in aortic valvar disease, and in other conditions where there is freedom from the extreme forms of mitral obstruction and incompetence. Mitral valvar disease rarely calls for entry into the left ventricle, because the configuration and duration of the mitral diastollc murmur, the pulsation of the skin overlying the apex of the left ventricle, and the presence or absence of the left atrial stasis wave, indicate the size of the mitral orifice and the severity of the regurgitation. Left ventricular angiography is rarely needed because the important information can usually be obtained by injecting the radio-opaque medium into the left atrium or the root of the aorta. The left atrium is an injection site that may be used with advantage in coarctation of the aorta. The Brockenbrough technique appears to be more difficult and dangerous than the Ross, particularly when poorly constructed instruments are used, and it was thought that it should not be used until the operator is practized in the Ross technique. Percutaneous left ventricular puncture, with the mentioned provisos, appears to be safe and successful. The physiological information obtained has allowed increasing reliance upon the out-patient technique of phonocardiography and cardiac impulse recording for objective diagnosis in the majority of patients with disease of the left side of the heart.