Transseptal Left Heart Catheterization

Left heart catheterization by puncture of the atrial septum was introduced by Manfredi ( 1956) and elaborated by Ross (1959).We have investigated 65 patients by this method and present our results with particular reference to its safety and effectiveness. SUBJECTS AND METHODThe majority of the patients had rheumatic heart disease (Table I).The age range was 9 to 67 years and the distribution is shown in Table II.There were three patients under 17 years of age.The size of the left atrium was graded on X-ray (penetrated postero-anterior, right lateral, and right anterior oblique views with barium in the cesophagus) and was found to be normal in 11, slightly enlarged in 23, moderately enlarged in 29, and aneurysmal in 2 patients.The basic technique of transseptal left atrial puncture used was that described by Ross, Braunwald, and Morrow (1960).Briefly, this consists of introducing a 595 cm.long catheter into the right atrium from the right saphenous vein, threading the 61 cm.transseptal needle (Fig. 1) through the catheter and puncturing the septum in the region of the fossa ovalis with the needle.It has not always been found possible to make contact with the atrial septum in the lower half of the right atrial shadow as advised by Ross since a small left atrium frequently lies higher.When this is the case it is considered especially important to maintain the