Newer Techniques of Transseptal Left-Heart Catheterization

IN APRIL 1958, the author first succeeded in catheterizing the left atrium of a patient percutaneously by piercing the interatrial. septum from the groin with a long, curved, 17-gauge needle and advancing the ensheathing 7-French plastic catheter over the needle and into the left atrium.' Fine polyetlhylene tubing could then be threaded through the transseptal catheter without any danger of amnputation,2 in order to obtain left ventricular pressures. The shortcomings of this original technique were the poor-quality pressure tracings obtained through the fine intraventricular catheter anid the frequent inability to cross the m-itral valve opening. Attemiipts to maneuver the curved polyethylene transseptal catheter into the left ventricle were hindered by the frictional resistance of the septum. This difficulty has been overcome with the use of clear Teflon tubing which has a very low coefficient of friction. The left ventricles of 10 patients have been catheterized quite simply and safely by utilizing the following revised instrumentation and technique.