Venous Catheterization of the Heart

Congenital heart lesions are notorious for their lack of characteristic signs and symptoms. The addition of venous catheterization, as developed by Cournand and Ranges (1), to the work-up of these cases presents an opportunity for the recognition of certain defects, for an estimation of the physiological magnitude of the shunts of blood, and for the study of the circulatory dynamics of these patients. Details of the procedure and methods of calculation of blood flows have been reported elsewhere (2, 3, 4, 5). Findings in representative types of congenital heart disease are herein described.2 Auricular Septal Defect In the presence of an auricular septal defect, blood usually flows from the left auricle to the right auricle. The venous catheter is helpful in the recognition of this defect by two methods, as described by Brannon, Weens, and Warren (6). The catheter may be introduced through the defect (4, 5) or arterial blood may be found in the right auricle (4). The following case report illustrates both methods in the same patient. Case Report: K. R., a 43-year-old woman, had been a blue baby and had had cyanosis and clubbing of the fingers all her life. Since the age of 19 she had had exertional dyspnea, which had not been progressive. Physical examination showed her to be undernourished but active, with slight cyanosis and clubbed fingers and toes. The heart was enlarged to the left. A grade-3 diastolic murmur was present in the fourth left intercostal space. The pulmonic second sound was accentuated. There were no physical signs of heart failure. An electrocardiogram showed right axis deviation. Roentgenography (Fig. 1) and fluoroscopy of the heart revealed extreme dilatation and pulsation of the pulmonary artery and its branches. On venous catheterization (Fig. 1), the catheter entered the right auricle and passed through a defect in the auricular septum into a pulmonary vein, where the oxygen saturation of the blood was 98 per cent (Table I). The femoral arterial oxygen saturation was only 86 per cent. The catheter was subsequently introduced into the right ventricle and pulmonary artery. The results are shown in Table I. A diagnosis of auricular septal defect seemed justified on the basis of finding arterial blood in the right auricle and of introducing the catheter through the defect. Ventricular Septal Defect An uncomplicated defect in the interventricular septum results in a shunting of arterial blood from the left ventricle to the right ventricle. Its recognition by venous catheterization depends on finding a significantly higher content of blood in the right ventricle than in the right auricle. Two such cases have been recently described by Baldwin, Moore, and Noble (7). Case Report: H. B., a 10-year-old boy, kindly referred by Dr. Samuel A. Levine, had had a known murmur since infancy. He had grown and developed normally and denied any limitation of activity. There was no history of cyanosis.