Percutaneous left ventricular puncture in the assessment of aortic stenosis.

In the assessment of cases of aortic valve disease with a view to operation, the standard methods of investigation are of limited value. Right heart catheterization gives some indirect information by measuring the cardiac output and the pulmonary capillary pressure. Some information can be obtained from a study of the peripheral arterial pulse wave, but this too cannot always supply a definite answer. Two questions have to be answered in assessing a case of aortic valvar disease. The first is whether, in a patient with signs of pure aortic stenosis, symptoms such as angina or dyspnoea are due to the aortic stenosis or due to associated coronary disease or pulmonary disease. The second is whether aortic stenosis or regurgitation is dominant, in a patient who has a mixed lesion. These questions cannot be answered by indirect methods of investigation. Further information in such cases might be obtained by measurement of the systolic pressure gradient across the aortic valve. This has been a standard procedure in the case of pulmonary stenosis for many years. Measurement of the systolic gradient across the aortic valve is a routine procedure at operation for aortic stenosis. We have now developed a method by which this information can be derived from pre-operative left ventricular pressure measurements.