CHAPTER 1
A Brief History of Cardiac Catheterization
“If you want to understand anything, observe its beginning and its development.”
—Aristotle
History of a Procedure
A reader who flips through the first pages of this Pocket Guide might ask, “Do I really have to read this chapter to learn how to perform cardiac catheterization?” The rational answer is, “No.” Nonetheless, please be irrational; do not skip these pages. You will be able to review the fascinating story of human curiosity, courage, and dedication of physicians and scientists who pursued their work despite the prevailing clinical and scientific dogmas to set the stage for a new generation of investigators who moved the field from diagnostic to therapeutic procedures.
No one can accurately pinpoint the exact time when humans started to be interested in cannulating blood vessels and cardiac chambers, but it is known that ancient Egyptians, Greeks, and Romans were forming tubes from hollow reeds, palm leaves, and pipes to study the function of cardiac valves in cadavers.1 Many centuries later in 1733, British physiologist Stephen Hales performed the first catheterization of the arterial blood vessel in a horse using brass pipes and a glass tube.2 In 1844, French physiologist Claude Bernard was first to catheterize the left and right ventricles in animals by inserting a mercury thermometer into the carotid artery and jugular vein.3 Adolph Fick came up with a brilliant one-page note on the calculation of blood flow in 1870, which opened the experimental era of cardiac metabolism.4 Finally, in Eberswalde, Germany in 1929, Werner Forssmann self-cannulated his antecubital vein and guided a urological catheter into his right atrium documenting its location via chest x-ray.5 In 1941, Andre Cournand and Dickinson Richards began to utilize right heart catheterization to study cardiac output, and in 1956 they shared the Nobel Prize in Physiology and Medicine with Forssmann.
Lewis Dexter discovered in 1948 that by wedging the catheter into a distal branch of a pulmonary artery, it is feasible to record the height of the left atrial pressure.6 In the late 1960s, Jeremy Swan and William Ganz used a balloon-tipped flow-directed catheter in the right heart to continuously measure and monitor hemodynamic tracings.7
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