Episode 13-FIRST CORONAROGRAPHY
Coronary angiography is a test allowing to see the arteries of the heart using a dye and X-ray.
This way, we can see if the coronary arteries have blockages and what is their importance.
Before the era of coronary angiography
Before the 1960s, there was no other way to see these blockages except by means of an autopsy, which was not very practical.
"Do not put dye in the coronaries"
At the time, with the birth of catheterization, many myths persisted.
It was believed, among other things, that putting a catheter directly into the arteries of the heart would have disastrous consequences.
An indirect way to see them
In mid-1958, radiologist Charles Dotter found an indirect way of seeing coronaries by means of a catheter, a small plastic tube, installed at the beginning of the aorta. This catheter, equipped with an inflatable balloon at its extremity, allows, when inflated, to color only the root of the aorta, that is to say, the area where the coronary arteries begin.
By doing this, Dr. Dotter ended the myth that introducing dye in the coronary leads to ventricular fibrillation, a dangerous arrhythmia. This discovery gave birth to the coronary angiography.
Then, an accidental discovery
About 3 months later, in a cardiac catheterization laboratory at the Cleveland Clinic, cardiologist Mason Sones was getting ready to do a catheterization of the aorta, that is to color the aorta. The catheter was well placed at the beginning of Mr. Abner Darby's aorta.
Dr. Sones asked his student to inject the dye to see the aorta on the X-ray. Dr. Royson Lewis engaged the mechanism.
The pressure inside the catheter generated by the injector gave it a new orientation and injected the dye directly into the right coronary. Both doctors were convinced that death was imminent. They expected to see this 47-year-old patient die from ventricular fibrillation.
Apart from a significant slowdown and short heart rate, nothing happened.
Once again, cardiology was revolutionized.
The beginning of selective coronary angiography
It was now possible to selectively inject the dye directly into the coronary arteries into the left coronary and the right one separately.
In this way, it is easier to see the coronary heart disease and its importance.
This same process is still used today.
The evolution of knowledge over time
Coronary artery disease or heart artery disease had no name until then, in the late 1950s.
Already, in the 1700s, the symptoms of this disease were well known.
It took another hundred years for pathologists to describe these blockages in the coronaries.
Another century went by before the factors that increase the risk of developing coronary artery disease, namely, smoking, cholesterol and high blood pressure were identified.
New challenge: atheromatous plaques!
In the end, it was noted that atheroma, cholesterol plaques in the coronary arteries, could be the cause of angina, heart attacks and sudden death. This discovery opened the door to a new era, that is, the development of different treatments.
And then follow-through for Dr. Sones
Inhabited with a vision of things to come, Dr. Mason Sones then worked with engineers to develop catheters to facilitate the work of cardiologists who colored the arteries of the heart.
Ironically, cardiologist Sones died of lung cancer while smoking a cigarette.
Dr. Melvin Judkins
The discovery of a more selective coronary angiography eclipsed the procedure set up by Dr. Charlie Dotter. But radiology did not say its last word in this story ...
Dr. Dotter delegated a young radiologist to Dr. Sones in Cleveland for training. The young Dr. Melvin Judkins quickly realized that it is not easy to install small plastic tubes called "catheters" in the coronary arteries.
However, he found that the starting point of each coronary, right and left, is always located in the same place, from one individual to another. As a result, he developed a new series of catheters.
"Judkins" catheters are better suited than "Sones" catheters. They make coronary angiographies easier with less harmful x-ray exposure for doctors.
These catheters are still used today.