Selective transseptal angiocardiography

Angiocardiography with right catheterization by the selective injection o contrast medium into the left atrium is practicable only if a defect in the atrial septum or a patent foramen ovale permits passage of the catheter (8) ; if the atrial septum is intact, puncture of the left atrium will be required.Although retrograde catheterization of the left atrium via the aorta and left ventricle is possible, it is a difficult procedure and rarely succeeds.Selective angiocardiography of the left atrium has previously been carried out as a rule by direct puncture of the left atrium either percutaneously from behind (2, 9) or via a bronchoscope in the left main bronchus (3).The former method in particular affords satisfactory and rapid selective contrast filling of the left atrium. Ross (1959) (13) reported a new technique for catheterization of the left heart.The method is based on transeptal puncture of the left atrium with the aid of a needle just over 70 cm long introduced via the right femoral vein.We have used this method for over six months but have found the following modification to be required for angiocardiography.After percutaneous puncture (15) of the right femoral vein, a specially designed, thin-walled radiopaque polythene catheter of the Odman-Ledin type (1 l ) , 65 cm long and blue in colour (AB Kifa, Solna 3, Sweden) is placed with its tip in the right atrium.This catheter permits not only a higher injection rate but easier passage of the puncture needle than a conventional yellow Odman catheter.