The History of Cardiac Catheterization by Laura J.Walker, RN, CCRN.

The awe, myths and function of the human heart has intrigued humanity since ancient times.

It was not until about a century ago did the medical world begin to unravel and expose the mysteries of the heart.

An English physician in the 1860’s who challenged the mysticism surrounding the heart. The reputed father of Cardiology is credited with bringing medicine from the Dark Ages into the light of science and inquiry.

With dedicated scientific experiments and observations, William Harvey indentified and introduced the circulatory system function.

His work is considered the 17th century’s most significant achievement in physiology and medicine.

A French research physiologist in 1844 who used catheters in horses to record intracardiac pressures.

He coined the term “cardiac catheterization.”

The 1st cardiac catheterization was performed on a horse in 1884.

A Physics professor in 1895 who was working on the range of cathode rays outside of charged glass tubes. When a cardboard covered tube was charged, an object glowed in the room. When Roentgen put his hand out to block the glow, he saw his bones outlined.

He noticed the x-ray discharge was able to pass through some materials such as glass, wood and bone.

This famous picture that eventually lead to him receiving the Nobel Prize for Physics was actually an x-ray of his wife’s hand.

The invention of x-ray gave the medical realm a method to view the human body from the outside in.

A German surgical resident in the 1920’s who was studying the effects of administering medications directly into the heart. His goal was to find a safe and effective way to inject drugs for cardiac resuscitation.

He punctured a vein in his left forearm, threaded a bladder catheter into the antecubital vein, advanced the catheter 65 cm into his vein, walked down to the x-ray department and had a picture taken of his chest to show that the catheter tip was in his heart.

He performed the first successful cardiac catheterization on a human, himself!

Forssmann’s new passion was to demonstrate that the heart could be injected with x-ray dye in order to illuminate the actual inner pumping chambers.

X-ray dye visualization was only used to view the bladder. Intravenous injections of contrast were not attempted because it caused excruciating pain and injected the patient with a toxic mix of heavy metals.

The thought of dumping x-ray dye into the human heart to visualize the chambers was convinced to create a pooling of heavy metals in the heart and induce cardiac arrest.

The Half Solved Mystery

As technology in radiology improved, the ability to pass a catheter up into the aorta emerged and the capacity to view the structural foundation of the heart was born.

Yet unable to actually visualize the coronary vessels that feed the heart muscle was untouchable due to the fear of injecting contrast directly into the coronary vessels would cause certain death.

It was not until an accident happened in a cath lab that changed how we identify and manage coronary disease.

Mason Sones The cardiologist who introduced a

new era in cardiovascular medicine.

Already performing cardiac catheterizations in 1958 to view the heart structure and its chambers, no one dared to inject contrast directly into the coronary vessels.

During a routine catheterization, Sones’ accidentally injected the right coronary artery directly with contrast, at first he thought the patient was going to go into cardiac arrest but instead the patient remained awake and alert.

He visually displayed the hidden secrets of the coronary arteries therefore opening the door for coronary bypass surgery to restore blood flow.

Coronary Bypass Surgery

As technology advanced in x-ray and catheterization techniques, the capability to illuminate the actual blood vessels and chambers of the heart became a reality but the mystery was half solved.

Physicians still had no clue on how to fix the coronary vessels that were now visible without the enormous risk of open heart surgery.

For many people suffering from coronary artery disease the treatment options were limited and dangerous.

Charles Dotter

The main theme of Dotter’s work was to use of catheters for the diagnosis and treatment of vessel disease in an attempt to replace the scalpel.

His greatest contribution was the development of the interventional catheter, this gave him the ability to perform a catheterization and then allowed him to insert rigid dilators through the catheter to open blockages in the arteries in the legs.

His work in opening the vessels in the legs without the need for surgery was remarkable, but his equipment remained bulky and difficult to work with.

Melvin Judkins

Working alongside of Charles Dotter, Dr. Judkins created his own specialized catheters to visualize the coronary arteries selectively.

Dr. Judkins changed the technique of cardiac catheterization by perfecting the transfemoral approach which allowed the introduction of the catheter via a groin puncture rather than the more complex procedure by Sones of introducing the catheter via surgical opening of the brachial artery in the arm.

Visualization of the coronary circulation ultimately led to the introduction of coronary bypass and angioplasty.

Andreas Gruentzig

As a young doctor in Zurich Germany, Andreas Gruentzig became possessed by a vision to develop the tools that would configure the disease ridden arteries of the heart.

He created inflatable miniature balloons placed at the ends of slender catheters that could be slipped into the vessel depths and placed across a narrowed vessel filled with plaque. The balloon would then be inflated causing compression of the plaque into the vessel wall and causing reconfiguration of the vessel and thus creating a wider vessel lumen for blood flow.

From Scalpel to Scalpel-less

On September 15, 1977 Dr. Gruentzig performed his first percutaneous transluminal coronary angioplasty on a 38 year old insurance salesman.

With a packed audience of supporters and non-believers to watch the epic first case, Andreas used Dr. Judkins technique of accessing the femoral artery with a needle instead of a scalpel. He then gently wedged open a tight lesion in the coronary artery with one of his balloons. To the surprise of all, the patient remained awake and alert and had no chest pain.

At the end of his first procedure, Andreas started to realize that his dreams had come true

The Fundamental Work

Thanks to Gruentzig, the dreams of Forssmann, Dotter and Sones have been transformed into a stunning therapeutic reality to benefit millions of patients today.

Any person with cardiovascular disease, which means about every fourth adult in the United States, now stands a good chance of undergoing life enhancing treatments that could not even have been imagined a generation ago.

The Future of a Vision

Procedure rooms are now becoming the operating rooms of the future.

We are able to lessen open procedures, putting down the scalpel to embrace maneuvering of catheters and insertion of drug eluting stents, percutaneous valves, left ventricular assist devices and many more procedures to come under the guide of fluoroscopy, endovascular imaging and simulation 3D technology.

The study of genetics and cellular functions will support future strategies in preventing, diagnosing and treating coronary artery disease.

•With the desire of finding a way to help humanity live a longer healthier life, a steady stream of innovative passionate physicians unlocked the mysteries of the heart that transformed the medical realm.

•Armed with knowledge of heart disease and management , many great physicians of this millennium continue the quest to grasp the wonders of the heart.

•Everyday, remarkable and skillful physicians treat and combat the effects of heart disease with an unyielding conviction of one day discovering a cure.