A modified technique for transseptal angiocardiography: review of 186 cases

Perforations of the left atrial or ventricular wall and extravasations of contrast medium during transseptal left heart catheterisation or angiocardiography can be eliminated by replacing the normally used transseptal catheters by Pigtail-catheters. With only 2.8% minor complications without sequelae in 181 successful studies, transseptal angiocardiography of the left heart through Pigtail-catheters is not only less hazardous than injections through the transseptal catheters used up to now, but possibly bears even less risk than direct retrograde injection into the left ventricle. The best method of showing the left atrial cavity and the mitral valve is transseptal left atrial injection. According to our findings in the evaluation of the ventricular function by means of quantitative angiocardiography, transseptal angiocardiography with injection into the left atrium is preferable to retrograde direct ventriculography, as ventricular ectopic beats were absent and supraventricular ectopic beats were as rare as 5% of cases. With this method, local disturbances of wall motion during injection could also be avoided and one or two more cycles could be evaluated before the depressant effect of contrast medium started.