Aortic stenosis catheterization revisited: a long sheath single-puncture technique.

Objectives: To evaluate the accuracy of a new long sheath single-puncture technique in obtaining accurate transvalvular gradients in aortic stenosis.

Background: Despite advances in echo Doppler, the evaluation of aortic stenosis continues to be a common procedure in the cardiac catheterization laboratory. Experts agree that simultaneous evaluation of the proximal aortic and left ventricular pressures yields the most accurate data; however, this is difficult to achieve unless two arterial punctures are performed.

Methods: We postulated that using a 4 Fr pigtail catheter inside a 55-cm long 6 Fr sheath would provide accurate simultaneous pressure data, yet avoid the complications of two arterial punctures. We performed this technique in 13 male patients, and placed a second arterial catheter in the aortic root as a control aortic pressure. We then performed this technique in 55 other male patients without placing an additional control arterial catheter.

Results: In the test population, correlation of aortic valve areas and transvalvular gradients was excellent. In the larger population, adequate hemodynamic data was obtained in 52 patients, with no difficulty engaging coronary arteries or grafts via the long sheath, and with an acceptable major complication rate of 1.5%.

Conclusions: Using a 4 Fr pigtail catheter with a 55-cm long 6 Fr sheath is a safe, efficient way to obtain excellent hemodynamic data in an aortic stenosis catheterization procedure.