Safe transthoracic left ventricular puncture performed with echocardiographic guidance

Retrograde aortic left ventricular pressure recording is difficult to obtain and often unreliable in the presence of a mechanical aortic valve prosthesis. Under echocardiographic guidance, we have safely performed transthoracic left ventricular puncture for pressure recording in seven patients with an aortic valve prosthesis. The transducer is placed at the left sternal border and then slid laterally until the right ventricular cavity and interventricular septal echoes disappear, but before the echoes from the left lung are recorded. The chest wall is marked and the transducer is angled until the mitral valve echoes are identified. The transducer angle and direction are recorded with external markers, and the left ventricular cavity depth is measured. An 18-gauge needle is then inserted the determined depth into the left ventricle, guided exactly by the echocardiographic external markers. The procedure was successful in each patient on the first attempt without a single complication. We conclude that this technique affords the operator greater control when left ventricular pressure must be recorded by transthoracic puncture and that it may reduce the risk of potentially serious complications.