Left heart catheterization with special reference to the transseptal method.

In the early nineteen-fifties the emergence of cardiac surgery called for accurate diagnosis, and it became necessary to catheterize the left side of the heart. The left atrium was entered by needles inserted through the tracheal wall, the suprasternal notch, and the back of the chest; and the left ventricle was entered by needle puncture, or by the passage of a catheter from the left atrium or the aorta (Lancet, 1957). These methods had diagnostic limitations or disadvantages, and dangers that restricted their use to hospitals where thoracic surgeons were available to deal with the complications (P. Wood, 1961, personal communication). In 1959 John Ross jun. described atrial septal puncture as a means of entering the left side of the heart, and early in 1960 one of us reported a series of 57 patients (Nixon, 1960). This series has now been extended to 508, and the results suggest that the technique may be safe enough to be performed with right heart catheterization in the physician's catheter laboratory. Nearly every patient investigated was a candidate for the surgical treatment of his heart disease, and the need for an accurate estimate of the morbid physiological changes justified a small risk when the alternative course was to operate, or to withhold surgical treatment, on the basis of a diagnosis that was something less than exact. The majority of the patients had mitral valvar disease, and the number investigated reflects the inaccuracy of the traditional methods of diagnosing the various syndromes of obstruction and incompetence. Percutaneous puncture of the left ventricle and/or percutaneous catheterization of the aorta was performed in addition to the atrial septal puncture when the need arose. The purpose of this communication is to describe our experience of the three techniques and