Percutaneous Puncture of the Left Ventricle

Left heart catheterization has become an increasingly important method for the pre-operative assessment of patients with congenital or acquired heart disease, and in recent years a variety of techniques have been introduced for gaining access to the left atrium and left ventricle (Morrow et al., 1960). When the usual clinical examinations indicate the need for such study the physician must select the method of left heart catheterization that will provide the information, in a particular patient, with a minimum of risk and discomfort. One of the techniques most commonly employed for access to the left ventricle is anterior percutaneous puncture. Although this method has been widely used since it was described and popularized by Brock and co-workers in 1956, relatively little information is available concerning experiences with this technique (Fleming et al., 1958; and Raynaud et al., 1959). At the National Heart Institute left ventricular puncture has been employed in the course of 226 haemodynamic studies. The present report constitutes a description of the techniques and a summary of the experience with the procedure in this clinic. TECHNIQUE Left ventricular puncture is performed only in the operating room or cardiac catheterization laboratory. Systemic arterial pressure and the electrocardiogram are continuously monitored throughout the study. Equipment for internal and external cardiac defibrillation is immediately available and a surgeon experienced in the techniques of resuscitation is present. Adult patients are given pentobarbital 100 mg., orally, one hour before the procedure. Children usually receive a combination of meperidine, phenergan, and promazine, which is supplemented during the catheteri- zation, if necessary, with light general anesthesia.