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METHOD FOR RECORDING AORTIC PRESSURE PULSES' BY S. RADNER
From the Department of Medicine, University of Lund, Sweden
(Received for publication Oct. 6, 1952)
Aortic hemodynamics have been but little explored in man, probably because no simple method of investigation has been available. The few studies made on human subjects (Salans, Katz, Graham, Gordon, Elisberg & Gerber, 1951, Schnabel, Fitzpatrick, Peter- son, Rashkind, Talley & Raphael, 1951, Rad- ner, Cournand, Cathcart & Fishbein, to be published.) have involved catheterization of the aorta from a peripheral artery.
We have been applying a new method for this purpose, which might be suitable for routine use. The arch of the aorta is punc- tured percutaneously from the suprasternal notch in the neck, and recordings of the aortic pressure pulses are made through the needle.
EQUIPMENT A simple needle instrument was constructed
(Fig. 1). The needle, which has an outer diameter of 0.9 mm and an inner diameter of 0.5 mm, is mounted on the straight limb of a three-way stop- cock. The needle is supported by a closely fitting cylinder which surrounds its proximal 4 cm. The free distal length of the needle is 10 cm. Through the straight limb of the stop-cock a stilette is in- serted into the needle. The transverse limb of the stop-cock is connected with an infusion bottle, con-
1 Presented at the Staff Meeting of the Univer- sity Clinics, Lund, Sweden, September 11, 1952.
taining saline-heparin solution under suitable pressure.
After the aorta has been punctured, the stilette is withdrawn and the needle connected with a Tybjaerg Hansen manometer, by means of a canal- ized knob and a small piece of a Cournand catheter, size 6 or 7.
Fig. 1. Needle instrument for suprasternal puncture of the aortic arch. N = Needle with three-way
stop-cock. S = Stilette with bayonet knob. I = Infusion tubing. C = Catheter with
canalized bayonet knob.
129
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130 S. RADNER
Fig. 2. The needle is introduced through the supra- sternal notch into the aortic arch.
TECHNIQUE
The exact position of the aortic arch in frontal and lateral views is determined through fluoroscopic screening by the operator, immediately before the punchure in each case.
With the patient in a supine position and his face turned to the left, the needle is in- troduced into the anterior mediastium (Fig. 2). Local anaesthesia is used. The needle is directed in its course according to the fin- dings at the fluoroscopy. The vigorous pulsations of the aortic arch are left with the needle, usually at a depth of 4 to 7 cm. The skin around the needle can be elevated in a tent-like manner before the wall of the arch has been perforated. When the tip of the needle has been inserted through the aortic wall, the vigorous pulsations are no longer felt, and the skin cannot be elevated aronud the needle. Continuous infusion is maintai-
ned through the needle when recordings are not being taken.
Premedication is not necessary. If proper local anaesthesia has been administrated, the patient experiences little or no discomfort. Complications have not been encountered.
PRELIMINARY RESULTS Our material is so far limited, but a
broader use of the method is planned in 3 variety of cardiovascular lesions. The met- hod is evidently a safe and simple way oi obtaining accurate recordings of the pressure pulses in the aorta.
The aortic pressure curve from a case of patent ductus arteriosus, verified at opera- tion, is shown in Figures 3.
SUMMARY A new method for recording aortic pres-
sure pulses is described. The aortic arch is punctured percutaneously from the neck, and recordings are made through the needle.
Fig. 3. Aortic pressure curve from a case of patent ductus arteriosus, woman aged 20 years. Note “nipple-like” type of curve. At operation, the ductus was hour-glass-shaped, and its smallest cir- cumference was 22 mm. There was no pulmonary
hypertension.
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AORTIC PRESSURE PULSES 131
Schmbel, T. G., Fitzpatrick, H. F., Peterson, L. F., Rashkind, W. J., Talley, D. Br Raphael, R. L.: A technic of vascular catheterization with small plastic catheters. Its utilization to measure the arterial pulse wave velocity in man. Circula- tion 5, 257, 1952.
R E F E R E N CE S Radner, S., Cournand, A., Cathcart, R. & Fish-
bein, A.: To be published. Salans, A. H.. Katz, L. N., Graham, G. R., Gordon,
A., Elisberg, E. I. & Gerber, A.: A study of the central and peripheral arterial pressure pulse in man. Circulation 4, 510, 1951.
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