Episode 11-THE BIRTH OF CARDIAQUE CATHETERIZATION
Cardiac catheterization is an examination that the doctor prescribes to verify the work done by the heart and to measure different pressures in the heart and lungs. A short stay at the hospital is expected for this examination.
It is useful and particularly important in the evaluation of sick heart valves and their impact on the heart.
The examination also highlights certain congenital anomalies such as interventricular communication, for example.
Cardiac catheterizations are frequently used along with echocardiograms before cardiac surgery.
Let's see the impact of its discovery and the setting up of cardiac catheterization laboratories.
How cardiac surgery began
At the very beginning of cardiac surgery, the most disastrous complication, during and immediately after surgery, is the result of a preoperative misdiagnosis.
Limited diagnostic tools
At the time, doctors were required to do a simple physical examination with a stethoscope in their ears, as well as an electrocardiogram and an x-ray of the lungs.
Possible tragic repercussions
Once the surgery began, it was not uncommon to see a much more complex disease than previously expected with tragic repercussions afterwards.
It is difficult for a doctor to meet a family to say that the child did not survive the surgery because of a misdiagnosis.
An unlikely story
The need was more than necessary.
Before surgery, cardiac surgeons needed images of heart chambers, valves, and how blood flowed through the heart. This therefore stimulated radiology to develop cardiac catheterization.
The origin of cardiac catheterization is perhaps the most implausible story of all cardiology, if not of all medicine.
Young doctor obsessed with an idea
The story begins during the Second World War, in a small German hospital. In 1929, a young 24-year-old resident doctor, until then unknown, was obsessed with an idea.
Dr. Werner Forssman is convinced that a drug administered directly to the heart is more effective than if it is given through a vein in the arm.
A leader opposed to experimentation
He believes that a tube could be introduced into a vein of the arm and then be hoisted to the right atrium.
Dr. Peter Schneider, the medical chief, opposes to experimenting this idea. He is even opposed to the idea of his young student experimenting on himself.
A nurse becomes an accomplice
Two weeks later, with the help of a nurse who he slowly convinced of the validity of his idea, he goes ahead with his experimentation.
The nurse, Gerda Ditzen, gives him the essential elements for his experimentation. She provides him with a scalpel, a local anesthetic and a urinary catheter more commonly known as the "urinary catheter".
He introduces into himself a urinary catheter into a vein
He finds himself in an empty room. Dr. Forssman ties his nurse to a bed to make sure she will not let him down. He managed to introduce this “urinary catheter” into his own vein in his arm.
Then, nothing happens. No arrhythmia, no ventricular defibrillation, no loss of consciousness, nothing!
An X-ray of the lungs proves everything.
A mixed reaction from the chef
Faced with the facts, Dr. Schneider does not know what attitude to adopt. His resident disobeyed, but nothing serious happened. Maybe it's even a discovery?
A rather cold reception
Dr. Forssman publishes his result in a German medical journal in 1929. The results are disappointing. There is little interest in his discovery. On the contrary, it is mentioned that this is of no value and that in addition this technique has a huge potential risk.
German cardiology closes the door definitively on this idea.
Dr. Forssman will leave cardiology to become an urologist.
The idea retaken and improved
At the climax of the Second World War, Dr. André Cournand and Dr. Dickson Richards took up Dr Forssman's idea. They adjusted it to the concept of measuring the pressures of the different cardiac colored chambers using X-rays as well as the measurement of the cardiac output, or the efficiency of the heart to pump the blood.
The birth of catheterization
These measures help treat seriously injured soldiers. The war transformed a primitive idea of Dr. Forssman into a practical tool of treatment. This is the birth of cardiac catheterization.
With the birth of cardiac surgery that followed the Second World War, (World War II,) preoperative diagnoses became a plague. Too many deaths occur because of these errors.
Several catheterization rooms are appearing.
Today, the place where these examinations are practiced is called the hemodynamic laboratory.
In 1956, Dr. Werner Forssman shared the Nobel Prize in Medicine with Dr. Cournand and Dr. Richards.
Quite the evolution
Eight years after the first mitral valve repair by Dr. Charles Bayley, the medical world had completely changed its mind about the event described by a young doctor. He had challenged the authority, coaxed a nurse to provide him with the items he could not get and tied up the same nurse while he was experimenting with his idea on himself.
From zero to hero
Not recognized by his peers at the time, Dr. Forssman gets the mention of "monumental contribution to science" when awarded his Nobel Prize.
From surgical complications
The birth of cardiac surgery and its development have highlighted catastrophic complications such as:
• The cardiac conduction block
• Ventricular fibrillation
• Preoperative misdiagnosis
Solutions are found
These deadly complications led to:
• The invention of the pacemaker or cardiac stimulator
• The development of catheterization laboratories
For the first time, we can see and understand cardiac malformations in a living patient and the impact of cardiac surgery on the cardiac function.
There is still work to be done
We still can not see the disease that causes the most heart deaths; the disease of the arteries of the heart. The problem needs to be addressed.