Left Ventricular Angiocardiography by Transseptal Puncture of the Left Atrium.

SELECTIVE angiocardiography of the left side of the heart is of prime importance for the accurate preoperative diagnosis of those lesions involving the mitral valve, ventricular septum, outflow tract of the left ventricle, or the aorta itself. The injection of contrast medium into the pulmonary artery for the demonstration of the left atrium and left ventricle is less satisfactory than the direct injection into those chambers. Until recently, left atrial and left ventricular angiocardiography has been achieved only by retrograde left ventricular catheterization or direct transthoracie puncture of the left atrium or left ventricle. Many reports deal with the advantages and disadvantages of these methods.1 5 The introduction of transseptal left heart catheterization6-9 was a major step forward in achieving safe access to the left side of the heart. Since its first description, the method was modified mainly for the purpose of left heart angiocardiography.10-13 There are several reports in the literature about the safety and reliability of transseptal left heart catheterizationl, 9, 10, 14, 15 whereas only a few studies on selective left heart angiocardiography by the transseptal route are available.1'0 12, 16, 17 Recently, Braunwald and co-workers17 published their experiences with 60 patients investigated with this new technic. It is the purpose of this paper to discuss the findings obtained in 90 patients in whom transseptal left heart angiocardiography has been performed.