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Cardiac catheterization techniques: Normal hemodynamics

Morton J Kern, MD, MSCAI, FAHA, FACC
Section Editor
Donald Cutlip, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Hemodynamic data have always been, and remain, an integral part of all cardiovascular observations. Significant advances in both surgical and nonsurgical techniques for heart disease have been established in the last decade, in large part due to innovations both within and outside the cardiac catheterization laboratory. Many difficult forms of heart disease can now be readily confirmed with the improvement in two-dimensional and Doppler echocardiographic techniques. However, given the nature of clinical testing, there will always be suboptimal noninvasive examinations or patients in whom such testing cannot be performed. Thus, the catheterization laboratory remains critical to accurate measurements and the establishment of diagnoses. The presence of coexisting hemodynamic abnormalities in patients with coronary artery disease, myocardial infarction, cardiomyopathy, or peripheral arterial disease cannot be established without direct information.


Routine catheter access is obtained from either the radial or femoral artery and a convenient vein in most situations. The radial artery approach has gained wide acceptance and demonstrated reduced bleeding complications relative to femoral artery access. Many laboratories now use radial access as the default approach for routine cardiac catheterization [1-4]. An antecubital vein on the same arm is often used for right heart catheterization when using the radial approach for arteriography and left ventricular (LV) hemodynamics.

In addition to standard arterial and venous vascular access, there are a variety of special access techniques that may be required for optimal hemodynamic assessment (table 1) [5-7].

Transseptal access to the left atrium or ventricle is most often employed when prosthetic valves are located either in the aortic or mitral positions. Direct left atrial pressure measurement via the transseptal approach is also highly desirable, if not critical, to accurate decision making in conditions such as mitral stenosis (image 1), in which the pulmonary capillary wedge pressure is unreliable as a surrogate for the left atrial pressure. Under fluoroscopic guidance the transseptal access is obtained using a Brockenbrough catheter that is passed through the atrial septum over a long needle that is used to puncture the septum at the fossa ovalis. This technique is commonly used for accurate assessment of mitral valve disease and as access for mitral balloon valvuloplasty and a clip technique for percutaneous repair of secondary mitral regurgitation.

Direct LV puncture through the LV apex via the fifth intercostal space using echo-guided needle positioning is rarely used, but needed in patients with both aortic and mitral prosthetic valves blocking entrance to the LV. This technique is rarely used for diagnostic purposes but is applied for transapical aortic valve replacement. This method carries significant risk of bleeding and potential coronary artery damage.

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Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
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