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Figure 2. A method of folding the Simmons catheter curve within the ascending aorta (Method 2). In some patients with very tortuous and wide aortic arch, Method 1 cannot be utilized because advancing the guide wire to the descending thoracic aorta is impossible. In such cases, the reversed curve of the Simmons catheter can be made within the ascending aorta. (a) A guide wire loop is made within the ascending aorta with the top of the loop abutting the cusps of the aortic valve. (b) A catheter is then advanced over the loop of the guide wire. The course of the catheter and wire is blurred due to the cardiac motion. (c) Finally the catheter curve is obtained.
