Percutaneous Retrograde Catheterization of the Left Ventricle and Systemic Arteries of Man

Abstract

Since the prehistoric time when one of our ancestors learned that a sword could be thrust into the heart of his fellow man, progress has taken many pathways to varying objectives. The importance of one of the more peaceful of these objectives, controlled access to the left ventricle for medical purposes, has been evidenced by the acceptance of transthoracic needle puncture as a means justified by the end. That the left heart can now be reached without recourse to this or similar crude throwbacks to neolithic technic is, in large part, due to the efforts of Prioton and his colleagues (1). Following the valuable leads already provided by others (2–6), these French physicians developed an ingenious percutaneous technic for catheterizing man's left ventricle and systemic arteries. In one form or another, the method has subsequently been employed by numerous other workers (7–11). Guided percutaneous arterial catheterization is superior to, and will no doubt supplant, translumbar aortography. It is the diagnostic method of choice for the anatomic demonstration of patent ductus arteriosus, coarctation, and other abnormalities affecting the aortic arch; it provides reliable means for the study of aortic valvular disease and the direct demonstration of the hemodynamic consequences of mitral insufficiency; its value in pelvic, abdominal, cerebral, and peripheral arteriography is becoming recognized as familiarity is gained with this simple and effective technic. Experience acquired from the study of 157 patients with cardiovascular disease by this method forms the basis for the present report. Method In its essentials, percutaneous guided arterial catheterization is achieved by inserting a needle into a systemic artery—usually the femoral—and passing through the needle a long, flexible coil spring. The needle is withdrawn and polyethylene tubing slid sleevewise down the guide and into the arterial lumen. Figure 1 illustrates the salient features of this procedure. Fluoroscopic observation of the metallic guide facilitates catheter placement: when the latter has been accomplished, the guide is withdrawn, leaving the polythene tubing for the injection of radiopaque material and manometric observations. A more detailed description of technic is reported elsewhere (12). The key to the procedure is a long, flexible, coiled wire spring containing an inner wire stiffener.2 This serves the same general purpose as a plumber's “snake.” Since, in cooperative patients, general anesthesia is not required, the technic may be used on an out-patient basis. In most instances the femoral approach is selected. With the inguinal region suitably prepared, Novocain is injected and, through a nick in the skin, a needle large enough to admit the guide is inserted into the femoral artery. With its tip in a coaxial position,the guide is passed through the arterial blood spurting from the needle and advanced 3 or 4 inches up the arterial lumen. The incidence of the Dandy-Walker syndrome in hydrocephalic patients is difficult to assess, but it is quite rare (4, 14); we have found 85 cases in the world literature. There is no sex predilection. Approximately 60 per cent of the patients were under the age of two years at the time they presented with symptoms. The age range at the time of diagnosis was from newborn to fifty-nine years.