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Percutaneous Suprasternal Puncture (Radner Technique) of the Left Ventricle
Percutaneous
Suprasternal of the
Puncture (Radner Left Ventricle*
A Report W.
PHILLIP
CARR,
M.D.,**
A.
EDWARD
St.
M been
ANY
ADEQUATE
taming
METHODS
cardiac
appraised.’
FOR
facilities,
time
and
rapid
method
any cardiac ventricle.
OB-
first
puncture
of
and left dynamics.
atrium Others”
the
dure
to advantage
with
recent
described for
St.
the Louis
**Research
needle
on
withdrawn.
left
in specific
use
in
Fellow
of the of the
Heart Association. Supported in part by Missouri and St. Louis
artery of cardiac this proce-
disease
pulmonary
Cardiovascular University.
study used
great Missouri
a grant-in-aid from Heart Association.
technique1 In the first entered with Being
but
decision
deliberately
tricle tently
and with improved
tricular
entry.
after was
assessing
the
made
to
cau-
the
left
ven-
enter
experience we the percentage
have consisof left ven-
METHOD
Laboratory,
St.
M.D.
occasions.
Adult sedation is usually with morphine sulphate 10
vessels.7 and
MUDD,
different
However,
states,
embolism6
Diagnostic
ten
the
tiously
suprasternal
pulmonary the have
GERARD
somewhat fearful of tearing the left ventricle or aortic valve, the needle was quickly
in
the
J.
Since 1958, the suprasternal been used in 646 patients. cases, the left ventricle was
the
the safe
pressures
the
aorta,
transposition
*From
obtain
has 363
allowed,
particularly
AND
situation,
Radner2
and
to
chamber,
M.D.**
Missouri
have
and information desired will influence choice. This report is about a simple,
Cases
ROACH,
Louis,
hemodynamics
The
of 646
Technique)
diazepoxide
mg. tion
Louis the
of
hydrochloride
accomplished mg and chior(Librium)
100
The and
patient is placed in a supine posithe head is extended over the end a table and turned to the left as in Fig.
;}& ri-i
..
-
- -..__-1-__.
The line A shows the direction of the needle for the usual Radner approach to the aorta, artery and the left atrium. B is the modified procedure to enter the left ventricle or the right ventricle, The needle may remain in the lumen of the aorta as it progresses inferioriy and then enter the left ventricle through the aOrtic valve. In a frontal position, C demonstrates the needle position just after entry into the left ventricle having passed through the valve at the third intercostal space. FIGURE
1:
pulmonary
676
Volume November,
52,
1. The
No. 1967
PERCUTANEOUS
area
is washed
in the
SUPRASTERNAL
usual
manner
677
PUNCTURE
The
left
ventricle
is most
often
entered
by
and draped so that the patient can breathe adequately. The suprasternal and retrosternal region is infiltrated with 2 per cent
passing the needle sible and just to the
procaine
the aorta is followed to the aortic valve and entry is made through it, but occasionally
22
hydrochloride
gauge
through
a
2 inch
needle.
C of Fig.
in
1 and
A 7 inch thin wall 20 gauge needle is connected by a PE 280 polyethylene tub-
the
ing to a Statham P23Db which in turn is attached to
If the needle right ventricle
plifier
in
cording
a Sanborn system.
through
a
evaluation
550
The
DC of
first
Electrocardiographic cilloscope mit
as
constant In
needle
the
the
an
awareness
is directed
for on
an
of any Radner
posteriorly
os-
beeper,
recorder,
per-
arrhythmias. approach, and
the
to the
the
the
right
as
left.
the
lumen
be
pierced
of
be-
is entered.
is directed to the right, the is often entered as well as
ventricle
by
advancing
it in
atrium.
each
blood
site
verifies
entered, the
oxygen
the
position,
blood for the left side If there is any doubt,
withdrawal that
and dark a sample
of
is,
bright
for the right. is taken for
analysis.
A thrill
is often
as it approaches cification a change sage
2. The
may
ventricle
left
left At
in Fig.
atrium. The left atrium can be by a more posterior approach in Fig. 3. The needle will rarely
shown
the
as posas shown
artery
left
penetrated
enter
(dp/dt).
auditory
photographic
standard
passed
calibrated derivative
through
re-
is also
monitoring
and
as well
photographic
pressure
amplifier the
strain gauge, a carrier am-
pulmonary
fore
as far anterior left of midline
felt
a stenotic
through
the
aortic
needle
valve.
Cal-
of the valve sometimes requires in needle position to permit pas-
through
the
valve. RESULTS
A deliberate enter sternal patients ventricle
attempt
the left ventricle puncture. In (176 was
women, entered
has
been
with each 283 studies
made
to
supraon 256
107 men) the left in 161 individuals
N
)
2: the needle relation to vessels. FIGURE
This frontal view of the position for left ventricular the other heart chambers
heart
shows entry in and great
3: A sagittal of that shown in Fig. are similar to those vessels and chambers FIGURE
view from the opposite side 1. A and B needle positions in Fig. 1, and illustrate the entered.
ROACH
678CARR,
(56
per
cent).
percentage
has
With
more
experience,
risen
to
in
cases. years
The age range to 76 years. Most
were
in the
on
30
to
74
tered
62
times,
60
year
the
the
left
atrium
250
Complications infrequent. Of tricular ication
for
fever, (a
the
a
with
minimal The
cases)
has
at
four 182,
arteries
additional
of
nary
been
similar,
in
indicating
mediastinal
without
hematoma
incident
and
veloping cardiac pericardiocentesis rarely
persists
ness
in
the
that later.
discomfort
is
Patients
for neck
cardial
A
cardiac
of the fluid
long.
test
nor
within evident
Aortic
ECG
valve
(Lead
of
damage
procedure,
of as
sevat the
exercise in place,
has
plications
coroshould
than passing on coumadin should
have
a
per cent. Chilrequire a short
simplicity
of
by have
such
Brock
as
the had the
were
for
effective,
partype
left
ventricu-
the
incidence
with
this
attempted
studies with and as one
method
transbronchial
is increased the others.”
investigatorsTM
the patients, another
transthoracic’#{176} or Although the per-
approach is also
complications well as with Some
pen-
occurred,
the posterior approach.1”
lar pressures’3
full-
or
the
anesthetic. and
appreciated those who
cutaneous
and
no increased
hematoma
of puncture.
mild
ease
technique,”6 transseptal
complaint.
surgery
have
of
de-
has
time above 25 ten years usually
general
is readily ticularly
required
feeling
is a common
having
days
a slowly
myocardium
Puncturing
anticoagulants
The
heart.
pulmonary
no increased inciThere has been no
to the
if such
acting
cleared
had
injury
the or
any more of a problem the aorta. Patients
prothrombin dren under
the
Radner proprobably
of damaging
systemic
artery,
derivative
no addi-
tamponade one week
chest
Anterior
another
fear
be feared.
not be through
(646
that
that is
of the widespread,
in blindly advancing through high pressure
to
valves
one
puncture
the with
evidence
transient
complications
nor
table.
hypertension have dence of complications.
med-
emphysema),
and
Patients
pneumothorax
of suprasternal
has
acceptance not been
auscultation
the suprasternal might expect,
serious
and
even
test
to perform the
needle com-
disastrous.
I)
dp/dt
800
(mmHg/sec.)
400’ 100-
100
.
AP(mmHg) LVP
(mmHg)50
50 0
FIGURE
4:
drawal
of
A
the
typical needle
pressure across the
. curve valve.
obtained
in
of
DiscusSiON
the
and ven-
by
operating
51,
been minimal 161 cases of left
bullous
demonstrated the
due to the reluctance a needle into and
and
had
the Chest
entered was en255
three
Diseases
General
sequellae with the modified proceIn this group one patient had a su-
perior
sites
aorta
localized
percentage group
eral
been
hemoptysis.
entire tional dure.
the
pain,
had
patient
had
being atrium
16 required chest
one
not seen
times.
have
entry,
the
119
cedure
ventricle
234,
MUDD
group.
right
artery
last
has been from of the patients,
Besides the left ventricle 161 occasions, the right
pulmonary
the
AND
0 the
left
ventricle
(LVP)
and
aorta
(AP)
during
with-
Volume
52, No. 1967
November,
The
S
PERCUTANEOUS
ability
to
include
left
pressure measurement of suprasternal puncture formation test and
a safe aortic
in-
the risk of the the relative sim-
Obtain-
of the procedure. pressure has
pressure
derivative
and
provided
of the
evaluation
measuring
ventricular
of myocardial
the endthe
first
(Fig.
curve
4)
in
ventricle
was
This
entered
method
procedure
curve,
in
the
obtaining
left the
ventricle
an cases,
74
provides
for
gradient, sure and
patients,
161 times without In the last 119
increase the left
per
cent.
a safe
yet
ventricular end-diastolic first derivative of the
prespressure
extensi#{233}nde
incluye
el
izquierdo,
registro asi
guro, de
en
sencillo 363
trado hizo
de
como
ha resultado casos
presiones otras
Ia
intento
pacientes,
se
en
y
expeditivo.
el
ventriculo
penetr#{243} en
THERAPEUTIC
ventriculo
del
el
Ia
curva
de
presi#{243}n, asi
los
grupo
Cuando
y
pr#{243}ximos
el ventriculo
PROBLEMS
en
161
263 oca-
inclure
500 patients with pulmonary admitted to L’Hotel Dieu in Paris and found that 45 (9 per cent) had had “mmimal” lesions demonstrated on chest x-ray films taken previously, but had received no treatment at the time. These lesions were traced back from one to 18 years, Since a significant number of these “miiiThe
authors
studied
who
were
val-
ventriculo
el Ia
izquier-
primera
como
de
derivativa
otros
la technique
l’enregistrement
tricule
gauche
coeur,
bien
datos
in-
le
10
cas.
Quand
chez
les
283
malades
un
fois
sans
les
119
derniers
m#{233}thode
tique,
Ia
diastole
et
pression,
cas,
le ventricule
le
donne
s#{233}queiles.
ventricule
cent
un le
gauche
des
cas.
proc#{233}d#{233} stir
gradient
gauche
d’autres
aoren
d#{233}riv#{233}e des que
quoique
valvulaire
ventricule
bien
a #{233}t#{233}
des le
pour
premiere
aussi
stir
363
d#{233}lib#{233}r#{233} a #{233}t#{233} fait
cas,
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de
augmentation
obtenir
pression
yen-
cavit#{233}s
proc#{233}d#{233} simple
essai
#{233}t#{233} p#{233}n#{233}tr#{233} dans 74 pour
autres
groupe
suivants,
161
rapide
pour du
#{233}t#{233} p#{233}n#{233}tr#{233} accidentellement
a
dans
des
un
premier
gauche
Radner,
pressions
que
montr#{233}e
Dans
de
des
aussi
s’est
rapide.
fin
de
courbes
de
renseignements.
ZUSAMMENFASSUNG
Eine
Erweiterung in
der
alien
adern
einfache
In
ersten
der
und
von
Bei
der
letzten
der
Ventrikel dar, den
von
74%
der
eine urn
ersten wie
andere
For reprints, Grand, St.
IN
please Louis,
119
Ventrikel Schlagfolge.
Fallen
wurde
Dieses
doch
schnelle
diastolischen der will
write: Missouri
Ven-
n#{228}chsten
der
Enddruck Blutdruckkurve
Informationen list
SO-CALLED
der
der
und
Abschnitt
reference
erfolgte
des linken
Aortenklappenanstiegs-
ventrikul#{228}ren
den
eine
erwiesen.
F#{228}lle erreicht.
sichere den
als
Fallen
wurde Erh#{246}hung
Gruppe
wie
sich
in
Patienten
stellt
Complete
eine Punktion
ohne in
Methode
363
Versuchen
283
erreicht
hat
Methode
von
gezielten
zwecks
Herzventrikel
schnelle
Fallen
mal
linken
Herzr#{228}umen
Gruppe
10
Bei
druck,
Radner-Technik
im
sichere,
ENCOUNTERED PULMONARY
tuberculosis
extension
ebenso se
rE-
gradiente
RESUME
Une
und
fu#{233}pene-
casos.
en
Se-
el
formativos.
Vorgehen
coraz#{243}n,
primer
izquierdo diez
que
procedimiento
En
en
deliberado,
Radner, el
presi#{243}n en
de
Gruppe
cavidades
pr#{225}ctica tin
accidentalmente un
t#{233}cnicade
la
procedimiento
obtener
di#{225}stole y
161
Una
sequelas.
izquierdo
ciento. un
del
trikels.
RESUMEN
por
final
zuf#{228}llig in
information.
74
para
a#{243}rtico,la
auch
rapid valve
as other
seguro,
Druckregistrierung
aortic
as well
the
el
de
el ventrIculo
al
Cette
283
next
incidencia
do
Dans
made
in the
en
pero
vular
a
was accidentally entered a deliberate attempt was
entered sequellae.
pido,
atteint
the left ventricle in ten cases. When
Ia
m#{233}todo constituye
ventricule
Radner technique of pressures from
en
119 casos
penetrado Este
et
the left ventricle, as well as all other chambers has proved a safe, simple and rapid procedure. In the first group of 363 cases,
was
fue
aumento
uiltimos
los
du
function.
SUMMARY An extension of the to include the recording
sin
En
performance valuable
679
PUNCTURE
siones,
ventricular
the adds
and rapid method for evaluating valve gradient, left ventricular
diastolic for
in
without increasing does not change
plicity or brevity ing the ventricular
SUPRASTERNAL
zu appear
in
Dr. Mudd, 63104.
erhalten. the
reprints.
1325
South
MINIMAL
LESIONS
imal” lesions appear to develop into serious puhnonary tuberculosis, the question of treatment for them Is raised. The authors discuss the clinical, radiologic and bacteriologic aspects of these cases and the current therapy available for them. BARIETY,
de ltsions
M.. BONNIOT, dites minimes,”
R. #ow BENIT, C.: Rev. Tub. vi Pneu.,
“Constatation 1967.
31:24S.
Suprasternal of the
Puncture (Radner Left Ventricle*
A Report W.
PHILLIP
CARR,
M.D.,**
A.
EDWARD
St.
M been
ANY
ADEQUATE
taming
METHODS
cardiac
appraised.’
FOR
facilities,
time
and
rapid
method
any cardiac ventricle.
OB-
first
puncture
of
and left dynamics.
atrium Others”
the
dure
to advantage
with
recent
described for
St.
the Louis
**Research
needle
on
withdrawn.
left
in specific
use
in
Fellow
of the of the
Heart Association. Supported in part by Missouri and St. Louis
artery of cardiac this proce-
disease
pulmonary
Cardiovascular University.
study used
great Missouri
a grant-in-aid from Heart Association.
technique1 In the first entered with Being
but
decision
deliberately
tricle tently
and with improved
tricular
entry.
after was
assessing
the
made
to
cau-
the
left
ven-
enter
experience we the percentage
have consisof left ven-
METHOD
Laboratory,
St.
M.D.
occasions.
Adult sedation is usually with morphine sulphate 10
vessels.7 and
MUDD,
different
However,
states,
embolism6
Diagnostic
ten
the
tiously
suprasternal
pulmonary the have
GERARD
somewhat fearful of tearing the left ventricle or aortic valve, the needle was quickly
in
the
J.
Since 1958, the suprasternal been used in 646 patients. cases, the left ventricle was
the
the safe
pressures
the
aorta,
transposition
*From
obtain
has 363
allowed,
particularly
AND
situation,
Radner2
and
to
chamber,
M.D.**
Missouri
have
and information desired will influence choice. This report is about a simple,
Cases
ROACH,
Louis,
hemodynamics
The
of 646
Technique)
diazepoxide
mg. tion
Louis the
of
hydrochloride
accomplished mg and chior(Librium)
100
The and
patient is placed in a supine posithe head is extended over the end a table and turned to the left as in Fig.
;}& ri-i
..
-
- -..__-1-__.
The line A shows the direction of the needle for the usual Radner approach to the aorta, artery and the left atrium. B is the modified procedure to enter the left ventricle or the right ventricle, The needle may remain in the lumen of the aorta as it progresses inferioriy and then enter the left ventricle through the aOrtic valve. In a frontal position, C demonstrates the needle position just after entry into the left ventricle having passed through the valve at the third intercostal space. FIGURE
1:
pulmonary
676
Volume November,
52,
1. The
No. 1967
PERCUTANEOUS
area
is washed
in the
SUPRASTERNAL
usual
manner
677
PUNCTURE
The
left
ventricle
is most
often
entered
by
and draped so that the patient can breathe adequately. The suprasternal and retrosternal region is infiltrated with 2 per cent
passing the needle sible and just to the
procaine
the aorta is followed to the aortic valve and entry is made through it, but occasionally
22
hydrochloride
gauge
through
a
2 inch
needle.
C of Fig.
in
1 and
A 7 inch thin wall 20 gauge needle is connected by a PE 280 polyethylene tub-
the
ing to a Statham P23Db which in turn is attached to
If the needle right ventricle
plifier
in
cording
a Sanborn system.
through
a
evaluation
550
The
DC of
first
Electrocardiographic cilloscope mit
as
constant In
needle
the
the
an
awareness
is directed
for on
an
of any Radner
posteriorly
os-
beeper,
recorder,
per-
arrhythmias. approach, and
the
to the
the
the
right
as
left.
the
lumen
be
pierced
of
be-
is entered.
is directed to the right, the is often entered as well as
ventricle
by
advancing
it in
atrium.
each
blood
site
verifies
entered, the
oxygen
the
position,
blood for the left side If there is any doubt,
withdrawal that
and dark a sample
of
is,
bright
for the right. is taken for
analysis.
A thrill
is often
as it approaches cification a change sage
2. The
may
ventricle
left
left At
in Fig.
atrium. The left atrium can be by a more posterior approach in Fig. 3. The needle will rarely
shown
the
as posas shown
artery
left
penetrated
enter
(dp/dt).
auditory
photographic
standard
passed
calibrated derivative
through
re-
is also
monitoring
and
as well
photographic
pressure
amplifier the
strain gauge, a carrier am-
pulmonary
fore
as far anterior left of midline
felt
a stenotic
through
the
aortic
needle
valve.
Cal-
of the valve sometimes requires in needle position to permit pas-
through
the
valve. RESULTS
A deliberate enter sternal patients ventricle
attempt
the left ventricle puncture. In (176 was
women, entered
has
been
with each 283 studies
made
to
supraon 256
107 men) the left in 161 individuals
N
)
2: the needle relation to vessels. FIGURE
This frontal view of the position for left ventricular the other heart chambers
heart
shows entry in and great
3: A sagittal of that shown in Fig. are similar to those vessels and chambers FIGURE
view from the opposite side 1. A and B needle positions in Fig. 1, and illustrate the entered.
ROACH
678CARR,
(56
per
cent).
percentage
has
With
more
experience,
risen
to
in
cases. years
The age range to 76 years. Most
were
in the
on
30
to
74
tered
62
times,
60
year
the
the
left
atrium
250
Complications infrequent. Of tricular ication
for
fever, (a
the
a
with
minimal The
cases)
has
at
four 182,
arteries
additional
of
nary
been
similar,
in
indicating
mediastinal
without
hematoma
incident
and
veloping cardiac pericardiocentesis rarely
persists
ness
in
the
that later.
discomfort
is
Patients
for neck
cardial
A
cardiac
of the fluid
long.
test
nor
within evident
Aortic
ECG
valve
(Lead
of
damage
procedure,
of as
sevat the
exercise in place,
has
plications
coroshould
than passing on coumadin should
have
a
per cent. Chilrequire a short
simplicity
of
by have
such
Brock
as
the had the
were
for
effective,
partype
left
ventricu-
the
incidence
with
this
attempted
studies with and as one
method
transbronchial
is increased the others.”
investigatorsTM
the patients, another
transthoracic’#{176} or Although the per-
approach is also
complications well as with Some
pen-
occurred,
the posterior approach.1”
lar pressures’3
full-
or
the
anesthetic. and
appreciated those who
cutaneous
and
no increased
hematoma
of puncture.
mild
ease
technique,”6 transseptal
complaint.
surgery
have
of
de-
has
time above 25 ten years usually
general
is readily ticularly
required
feeling
is a common
having
days
a slowly
myocardium
Puncturing
anticoagulants
The
heart.
pulmonary
no increased inciThere has been no
to the
if such
acting
cleared
had
injury
the or
any more of a problem the aorta. Patients
prothrombin dren under
the
Radner proprobably
of damaging
systemic
artery,
derivative
no addi-
tamponade one week
chest
Anterior
another
fear
be feared.
not be through
(646
that
that is
of the widespread,
in blindly advancing through high pressure
to
valves
one
puncture
the with
evidence
transient
complications
nor
table.
hypertension have dence of complications.
med-
emphysema),
and
Patients
pneumothorax
of suprasternal
has
acceptance not been
auscultation
the suprasternal might expect,
serious
and
even
test
to perform the
needle com-
disastrous.
I)
dp/dt
800
(mmHg/sec.)
400’ 100-
100
.
AP(mmHg) LVP
(mmHg)50
50 0
FIGURE
4:
drawal
of
A
the
typical needle
pressure across the
. curve valve.
obtained
in
of
DiscusSiON
the
and ven-
by
operating
51,
been minimal 161 cases of left
bullous
demonstrated the
due to the reluctance a needle into and
and
had
the Chest
entered was en255
three
Diseases
General
sequellae with the modified proceIn this group one patient had a su-
perior
sites
aorta
localized
percentage group
eral
been
hemoptysis.
entire tional dure.
the
pain,
had
patient
had
being atrium
16 required chest
one
not seen
times.
have
entry,
the
119
cedure
ventricle
234,
MUDD
group.
right
artery
last
has been from of the patients,
Besides the left ventricle 161 occasions, the right
pulmonary
the
AND
0 the
left
ventricle
(LVP)
and
aorta
(AP)
during
with-
Volume
52, No. 1967
November,
The
S
PERCUTANEOUS
ability
to
include
left
pressure measurement of suprasternal puncture formation test and
a safe aortic
in-
the risk of the the relative sim-
Obtain-
of the procedure. pressure has
pressure
derivative
and
provided
of the
evaluation
measuring
ventricular
of myocardial
the endthe
first
(Fig.
curve
4)
in
ventricle
was
This
entered
method
procedure
curve,
in
the
obtaining
left the
ventricle
an cases,
74
provides
for
gradient, sure and
patients,
161 times without In the last 119
increase the left
per
cent.
a safe
yet
ventricular end-diastolic first derivative of the
prespressure
extensi#{233}nde
incluye
el
izquierdo,
registro asi
guro, de
en
sencillo 363
trado hizo
de
como
ha resultado casos
presiones otras
Ia
intento
pacientes,
se
en
y
expeditivo.
el
ventriculo
penetr#{243} en
THERAPEUTIC
ventriculo
del
el
Ia
curva
de
presi#{243}n, asi
los
grupo
Cuando
y
pr#{243}ximos
el ventriculo
PROBLEMS
en
161
263 oca-
inclure
500 patients with pulmonary admitted to L’Hotel Dieu in Paris and found that 45 (9 per cent) had had “mmimal” lesions demonstrated on chest x-ray films taken previously, but had received no treatment at the time. These lesions were traced back from one to 18 years, Since a significant number of these “miiiThe
authors
studied
who
were
val-
ventriculo
el Ia
izquier-
primera
como
de
derivativa
otros
la technique
l’enregistrement
tricule
gauche
coeur,
bien
datos
in-
le
10
cas.
Quand
chez
les
283
malades
un
fois
sans
les
119
derniers
m#{233}thode
tique,
Ia
diastole
et
pression,
cas,
le ventricule
le
donne
s#{233}queiles.
ventricule
cent
un le
gauche
des
cas.
proc#{233}d#{233} stir
gradient
gauche
d’autres
aoren
d#{233}riv#{233}e des que
quoique
valvulaire
ventricule
bien
a #{233}t#{233}
des le
pour
premiere
aussi
stir
363
d#{233}lib#{233}r#{233} a #{233}t#{233} fait
cas,
du
Ia
de
augmentation
obtenir
pression
yen-
cavit#{233}s
proc#{233}d#{233} simple
essai
#{233}t#{233} p#{233}n#{233}tr#{233} dans 74 pour
autres
groupe
suivants,
161
rapide
pour du
#{233}t#{233} p#{233}n#{233}tr#{233} accidentellement
a
dans
des
un
premier
gauche
Radner,
pressions
que
montr#{233}e
Dans
de
des
aussi
s’est
rapide.
fin
de
courbes
de
renseignements.
ZUSAMMENFASSUNG
Eine
Erweiterung in
der
alien
adern
einfache
In
ersten
der
und
von
Bei
der
letzten
der
Ventrikel dar, den
von
74%
der
eine urn
ersten wie
andere
For reprints, Grand, St.
IN
please Louis,
119
Ventrikel Schlagfolge.
Fallen
wurde
Dieses
doch
schnelle
diastolischen der will
write: Missouri
Ven-
n#{228}chsten
der
Enddruck Blutdruckkurve
Informationen list
SO-CALLED
der
der
und
Abschnitt
reference
erfolgte
des linken
Aortenklappenanstiegs-
ventrikul#{228}ren
den
eine
erwiesen.
F#{228}lle erreicht.
sichere den
als
Fallen
wurde Erh#{246}hung
Gruppe
wie
sich
in
Patienten
stellt
Complete
eine Punktion
ohne in
Methode
363
Versuchen
283
erreicht
hat
Methode
von
gezielten
zwecks
Herzventrikel
schnelle
Fallen
mal
linken
Herzr#{228}umen
Gruppe
10
Bei
druck,
Radner-Technik
im
sichere,
ENCOUNTERED PULMONARY
tuberculosis
extension
ebenso se
rE-
gradiente
RESUME
Une
und
fu#{233}pene-
casos.
en
Se-
el
formativos.
Vorgehen
coraz#{243}n,
primer
izquierdo diez
que
procedimiento
En
en
deliberado,
Radner, el
presi#{243}n en
de
Gruppe
cavidades
pr#{225}ctica tin
accidentalmente un
t#{233}cnicade
la
procedimiento
obtener
di#{225}stole y
161
Una
sequelas.
izquierdo
ciento. un
del
trikels.
RESUMEN
por
final
zuf#{228}llig in
information.
74
para
a#{243}rtico,la
auch
rapid valve
as other
seguro,
Druckregistrierung
aortic
as well
the
el
de
el ventrIculo
al
Cette
283
next
incidencia
do
Dans
made
in the
en
pero
vular
a
was accidentally entered a deliberate attempt was
entered sequellae.
pido,
atteint
the left ventricle in ten cases. When
Ia
m#{233}todo constituye
ventricule
Radner technique of pressures from
en
119 casos
penetrado Este
et
the left ventricle, as well as all other chambers has proved a safe, simple and rapid procedure. In the first group of 363 cases,
was
fue
aumento
uiltimos
los
du
function.
SUMMARY An extension of the to include the recording
sin
En
performance valuable
679
PUNCTURE
siones,
ventricular
the adds
and rapid method for evaluating valve gradient, left ventricular
diastolic for
in
without increasing does not change
plicity or brevity ing the ventricular
SUPRASTERNAL
zu appear
in
Dr. Mudd, 63104.
erhalten. the
reprints.
1325
South
MINIMAL
LESIONS
imal” lesions appear to develop into serious puhnonary tuberculosis, the question of treatment for them Is raised. The authors discuss the clinical, radiologic and bacteriologic aspects of these cases and the current therapy available for them. BARIETY,
de ltsions
M.. BONNIOT, dites minimes,”
R. #ow BENIT, C.: Rev. Tub. vi Pneu.,
“Constatation 1967.
31:24S.