COMBINED PERCUTANEOUS RETROGRADE AORTIC AND TRANSSEPTAL LEFT HEART CATHETERIZATION

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Abstract
Experience with 142 combined percutaneous retrograde aortic and transseptal left heart catheterizations has been presented. The advantages of this combination of the oldest and newest techniques of left heart catheterization are: (1) both catheters are introduced percutaneously from the right groin; (2) it allows a more complete hemodynamic, angiographic, and dye dilution assessment of left heart lesions than was previously possible during one catheterization procedure; (3) it can readily be combined with right heart catheterization, before, during, or after the left heart assessment; and (4) it avoids the need for multiple types of heart catheterization, thus saving time. The major risk of the procedure is that of aortic root puncture by the transseptal needle and catheter. This danger existed almost entirely in patients with gross left and right atrial enlargement: in these, the transseptal catheter appeared to slip up over the atrial septum to the region of the aortic root. Having the retrograde aortic catheter positioned in the root of the aorta helped to identify this vessel, and on occasion helped in avoiding mistaken aortic root puncture.