Brief History of Cardiac Catheterisation

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Brief History of Cardiac Catheterisation

• Gemma C. Ryder
• g.c.ryder_at_qmul.ac.uk

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Intra-cardiac catheter

• A thin tube passed to the heart via a vein or
  artery
• Used to withdraw blood
• Measure pressure in heart chambers or great
  vessels
• Inject contrast media
• For diagnosis and evaluation of congenital
  conditions and coronary artery lesions
• To evaluate systolic and diastolic cardiac
  function

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4 Major Events in CC History

• Development of techniques for measuring
  intracardiac physiologic events in animals
• Application of these techniques to humans
• Development of coronary angiography
• Development of catheter-based procedures

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Early catheterisation 1

•  In 1711, Stephen Hales conducted the first
  cardiac catheterisation of a horse using brass
  pipes, a glass tube and the trachea of a goose.

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Early catheterisation 2

•  In 1844, Claude Bernard inserted a mercury
  thermometer into a horse carotid artery
• Early chemotherapy required the injection of
  drugs directly into the central circulation.
  Bleichroeder inserted catheters into dog arteries
  and assessed the effects after leaving them in
  place for several hours. He reported no
  complications or clots.

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First catheterisation in a human

• In 1929, a German surgical trainee, Werner
  Forssmann, experimented on a human cadaver and
  realized how easy it was to guide a urological
  catheter from an arm vein into the right atrium

• In the early 1940's, Cournand, working in New
  York,began utilizing
• right heart catheterisation on a regular basis in
  the undertaking of a
• comprehensive investigation of cardiac function
  in both normal and
• diseased patients

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Development of catheterisation

• 1953 Seldinger developed a percutaneous approach
  for the introduction of catheters for both right
  and left heart catheterisation
• In the 1950's, diagnostic catheterisation became
  established as the best method for confirmation
  of clinical findings prior to cardiac surgery for
  valvular or congenital heart disease.

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Vascular Access

• Prior to Seldinger vascular access via cutdown
• Complications
• Haemorrhage
• Infection
• Acute thrombosis
• Distal embolisation

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Cut Down
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Seldinger Technique

• Inject local anaesthetic
• Locate artery
• Puncture with 18G needle
• Advance guidewire thru into artery
• Remove needle and advance introducer sheath

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Seldinger Technique
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Seldinger Technique
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Complications of Seldinger Technique

• Haemorrhage
• AV fistula
• Dissection
• Embolism/Thrombosis
• Closure
• Manual compression
• Closure devices

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Closure Device
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Closure Device 2
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Complications of Catheterisation

• Thrombosis
• Extrinsic - catheter material
• Heparin
• PTFE, coatings
• Intrinsic - endothelial damage
• Catheter design

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Coronary Angiography

• 1958 Accidental discovery by Sones
• Involves injecting contrast agent into the
  coronary arteries
• Cine-angiography
• X-ray images taken in rapid succession to capture
  the dyes progression

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Coronary Angiography
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Coronary Angiography
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Angiography Video 1
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Angiography Video 2
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Coronary Angiography
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Catheter-based procedures

• Valvuloplasty to open stenotic valves
• Pacemaker implantation
• Angioplasty 1974 peripheral/1977 coronary
• Atherectomy
• Lasers
• Stents

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Catheter based interventions are now very common

• 1997 over one million angioplasties performed
  worldwide, making angioplasty the most common
  medical intervention in the world
• 2001 almost two million angioplasties were
  performed worldwide, with an estimated increase
  of 8 annually
• 2002 the 25th anniversary of the first
  angioplasty performed in an awake patient