Combined Percutaneous Retrograde Aortic and Transseptal Left Heart Catheterization

Left heart catheterization in man has assumed increasing importance with the rapid advances in cardiac surgery for lesions of the left side of the heart. Zimmerman, Scott, and Becker (1950) were the first to perform left ventricular catheterization, passing a catheter in retrograde fashion from aorta to left ventricle. Subsequently the transbronchial (Facquet et al., 1952; Allison and Linden, 1953), transthoracic (Bjork, Malmstrom, and Uggla, 1953), suprasternal (Radner, 1954), and direct ventricular puncture (Brock, Milstein, and Ross, 1956) techniques have been used widely; but each has certain disadvantages (Morrow, Braunwald, and Ross, 1960). Ross (1959) and Cope (1959) almost simultaneously described the transseptal technique of left heart catheterization. Cope (1959) was the first to apply this technique in man. Ross, Braunwald, and Morrow (1960) have described the original transseptal technique in detail. Subsequently the improved and modified transseptal technique of Brockenbrough, Braunwald, and Ross (1962) has been described and has gained wide acceptance. This report describes our experience in combining this improved trans- septal technique with the retrograde technique of left ventricular catheterization. This represents a combination of the newest and oldest methods of left heart catheterization, a combination that permits a complete assessment of both stenosis and regurgitation at aortic and mitral valves, in- cluding hemodynamic, angiographic, and dye dilution studies, and overcomes some of the limita- tions encountered using either technique alone. Right heart catheterization may be combined easily with this procedure. One of the distinct advantages is the fact that both the transseptal and retrograde catheters can be introduced percutaneously from the right groin. McIntosh et al. (1961) have previously reported the combination of retrograde left ventricular catheterization with the original Ross technique of transseptal left atrial catheterization for the assessment of mitral valve disease. The combination of techniques described here is particularly suited for the assessment of lesions obstructing left ventricular outflow, as well as for the assessment of mitral valve disease.