Aortic Stenosis

IN THE STUDY of hemodynamics in aortic stenosis until the last decade more or less indirect methods were used, such as electrocardiography and phonocardiography, and direct and indirect pulse tracings. At best the results would confirm a clinical diagnosis but often were of little help in the surgical evaluation of the valvular defect. Only after the introduction of left-sided heart catheterization with pressure measurements in the left ventricle, by the transthoracic or transbronchial left atrial routes1 2 or percutaneous left ventricular puncture3 can the aortic stenosis be evaluated with respect to the systolic pressure gradient. Thoracic aortography call give valuable information in aortic stenosis concerning the mobility of the aortic cusps and the degree of post-stenotic aortic dilatation4 but does not reveal subaortic stenosis. Thoracic aortography is the routine method in assessing aortic regurgitation.5 Aortic catheterization may be extended to the left ventricle,6' 7where contrast injection may be done.8 This method carries the danger of damaging an aortic cusp or obstructing a coronary ostium.6' 9 Further, the roentgenologic study of the mobility of the aortic leaflets is disturbed by the presence of the catheter, and in tight stenosis the catheter adds to the obstruction and artificially exaggerates the systolic pressure in the ventricle. We have in the last years performed percutaneous puncture of the left ventricle with contrast injection in more than 120 cases.