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Transthoracic Left Heart Catheterization and Angiocardiography for Combined Assessment of Mitral and Aortic Valves

Transthoracic Left Heart Catheterization and Angiocardiography for Combined Assessment of Mitral... Transthoracic Left Heart Catheterization and Angiocardiography for Combined Assessment of Mitral and Aortic Valves 1 Morris J. Levy , M.D. 2 , Kurt Amplatz , M.D. and C. Walton Lillehei , M.D. Excerpt Retrograde left heart catheterization combined with selective ventriculography and aortography is essential for precise assessment of aortic and mitral stenosis or insufficiency (1). The type and degree of involvement, predominant lesion, and decision as to whether the disease is isolated or combined, are among the problems in preoperative evaluation and choice of treatment. A simple one-act technic is described for left heart catheterization combined with selective angiocardiography by which both valves (mitral by retrograde and aortic by antegrade study) are assessed in left-sided valvular disease where other methods have been inadequate or complicated. The equipment is shown in Figure 1. The patient is placed in a supine position. Children up to ten to twelve years are catheterized under light general anesthesia. Above that age local anesthesia is used. The apex of the heart is located when visible or palpable or is estimated by fluoroscopy or radiography, and after local procaine infiltration of the skin, subcutaneous tissue, and intercostal groove, a 1- to 2-mm. stab wound is made at this site. The needle, enclosed in a Teflon tube and containing a stiff diamond-shaped stilet, is inserted into the left ventricle through the apex of the heart (Fig. 1, D) The stilet is then removed. A stream of red blood under pressure indicates insertion into the ventricle. The needle is then pulled back, leaving the Teflon catheter in place. A metal spiral-wound stilet is then introduced through the Teflon tube, which is attached to a flushing chamber and syringe containing heparinized solution. Under fluoroscopic guidance, the flexible stilet is advanced across the mitral valve into the left atrium (Fig. 2), followed by advancement of the Teflon catheter until its end portion is well in the atrium. The stilet is then removed and continuous pressure is recorded while the catheter is slowly pulled back into the left ventricle. Contrast medium may be injected into the left atrium if desired. Next, the metal guide is again inserted through the catheter into the left ventricle and, under fluoroscopy, introduced into the ascending aorta. The catheter is then advanced across the aortic valve, pressure is recorded, and selective aortography is performed (Fig. 3). After the injection, the catheter is slowly pulled back and placed at the apical portion of the left ventricle, while continuous pressure is recorded (Fig. 4). This is followed by selective left ventriculography (Fig. 5). An adequate sized Teflon catheter, with end hole and two side holes at its distal portion, provides rapid injection of the medium. The short length of tubing (approximately 20 cm.) connecting the catheter and injector substantially decreases the resistance to the viscous contrast material. These two factors are valuable adjuncts to angiocardiography by this method. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Transthoracic Left Heart Catheterization and Angiocardiography for Combined Assessment of Mitral and Aortic Valves

Levy, Morris J.; Amplatz, Kurt; Lillehei, C. Walton
Radiology , Volume 78 (4): 638 – Apr 1, 1962
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Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1962 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/78.4.638
pmid
14464795
Publisher site
See Article on Publisher Site

Abstract

Transthoracic Left Heart Catheterization and Angiocardiography for Combined Assessment of Mitral and Aortic Valves 1 Morris J. Levy , M.D. 2 , Kurt Amplatz , M.D. and C. Walton Lillehei , M.D. Excerpt Retrograde left heart catheterization combined with selective ventriculography and aortography is essential for precise assessment of aortic and mitral stenosis or insufficiency (1). The type and degree of involvement, predominant lesion, and decision as to whether the disease is isolated or combined, are among the problems in preoperative evaluation and choice of treatment. A simple one-act technic is described for left heart catheterization combined with selective angiocardiography by which both valves (mitral by retrograde and aortic by antegrade study) are assessed in left-sided valvular disease where other methods have been inadequate or complicated. The equipment is shown in Figure 1. The patient is placed in a supine position. Children up to ten to twelve years are catheterized under light general anesthesia. Above that age local anesthesia is used. The apex of the heart is located when visible or palpable or is estimated by fluoroscopy or radiography, and after local procaine infiltration of the skin, subcutaneous tissue, and intercostal groove, a 1- to 2-mm. stab wound is made at this site. The needle, enclosed in a Teflon tube and containing a stiff diamond-shaped stilet, is inserted into the left ventricle through the apex of the heart (Fig. 1, D) The stilet is then removed. A stream of red blood under pressure indicates insertion into the ventricle. The needle is then pulled back, leaving the Teflon catheter in place. A metal spiral-wound stilet is then introduced through the Teflon tube, which is attached to a flushing chamber and syringe containing heparinized solution. Under fluoroscopic guidance, the flexible stilet is advanced across the mitral valve into the left atrium (Fig. 2), followed by advancement of the Teflon catheter until its end portion is well in the atrium. The stilet is then removed and continuous pressure is recorded while the catheter is slowly pulled back into the left ventricle. Contrast medium may be injected into the left atrium if desired. Next, the metal guide is again inserted through the catheter into the left ventricle and, under fluoroscopy, introduced into the ascending aorta. The catheter is then advanced across the aortic valve, pressure is recorded, and selective aortography is performed (Fig. 3). After the injection, the catheter is slowly pulled back and placed at the apical portion of the left ventricle, while continuous pressure is recorded (Fig. 4). This is followed by selective left ventriculography (Fig. 5). An adequate sized Teflon catheter, with end hole and two side holes at its distal portion, provides rapid injection of the medium. The short length of tubing (approximately 20 cm.) connecting the catheter and injector substantially decreases the resistance to the viscous contrast material. These two factors are valuable adjuncts to angiocardiography by this method.

Journal

Radiology – Radiological Society of North America, Inc.

Published: Apr 1, 1962

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