Cardiac catheterization is a medical test prescribed to evaluate how the heart functions and to measure pressures within its chambers and the lungs. It usually requires a short hospital stay.
This test is particularly useful in assessing heart valve diseases and their impact on cardiac function.
It can also detect certain congenital heart defects, such as a ventricular septal defect, and remains today an essential examination before cardiac surgery, complementing echocardiography.
The Beginnings of Cardiac Surgery
In the early days of cardiac surgery, the most serious complications often resulted from an incorrect preoperative diagnosis.
Physicians at the time had to rely solely on the clinical examination, listening to the heart with a stethoscope, the electrocardiogram—still rudimentary—and chest X-rays. These tools provided clues but were insufficient to precisely understand the internal structure of the heart and its bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood circulation.
When Diagnostic Errors Were Fatal
Once surgery had begun, it was not uncommon to discover a malformation far more complex than expected. Such diagnostic errors often had tragic consequences.
Surgeons were frequently faced with the painful task of explaining to families that a patient, often a child, had not survived surgery because the preoperative diagnosis had been incomplete or inaccurate.
The Need to See Inside the Heart
This situation created an urgent need: to see inside the heart and to measure what could previously only be estimated. Surgeons and radiologists began searching for a way to explore the heart’s chambers without opening the chest, to trace the path of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood, and to measure intracardiac pressures directly.
An Unbelievable Story
The need became increasingly pressing. Cardiac surgeons required accurate images of the heart chambers, its valves, and the flow of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood before any operation. This necessity led radiology to explore a new path: cardiac catheterization.
The origin of this technique remains one of the most astonishing stories in all of cardiology—if not in the entire history of medicine.
A Young Physician Driven by an Idea
The story begins in Germany in the late 1920s. In 1929, a 24-year-old medical resident named Werner Forssmann became convinced that a medication delivered directly into the heart would act faster and more effectively than if injected into a peripheral vein.
He imagined that a thin tube could be inserted into a vein in the arm and advanced all the way to the right atrium of the heart.
A Dangerous Idea
His supervisor, Dr. Peter Schneider, strongly opposed the experiment, judging it too risky. Forssmann even offered to perform the procedure on himself, but his superior categorically refused.
A Nurse as an Accomplice
Despite the prohibition, Forssmann managed to convince a nurse, Gerda Ditzen, to assist him. She provided the necessary items: a local anesthetic, a scalpel, and a sterile urinary catheter.
In an empty hospital room, Forssmann symbolically tied the nurse to a bed to ensure she would not intervene, then inserted the catheter into a vein in his left arm.
A Successful Experiment
The catheter was advanced approximately 65 centimeters, reaching the right atrium without causing arrhythmia or any complication. Forssmann then went to the radiology department, where an X-ray confirmed the position of the catheter inside his own heart.
He thus became the first person in history to perform a human cardiac catheterization.
A Cold Reception
Despite the technical success, his superiors’ reaction remained cautious. The article he published that same year, 1929, in a German medical journal, went largely unnoticed. Several colleagues considered the procedure both useless and potentially dangerous.
Forssmann abandoned cardiology soon afterward and turned to urology, setting aside his pioneering idea.
The Idea Revisited and Perfected
Nearly fifteen years later, during the Second World War, physicians André Cournand and Dickinson Richards in New York revived the concept.
They developed a safe method to measure intracardiac pressures, cardiac output, and oxygen saturation in the different heart chambers.
Their combined physiological and radiological approach quickly became a major research tool and helped improve the care of wounded soldiers, especially for evaluating shock and chest trauma.
The Birth of Modern Cardiac Catheterization
From these studies emerged the first systematic use of cardiac catheterization as a diagnostic procedure.
After the war, the technique was adopted in many hospitals and became a standard preoperative test before any cardiac surgery. The first catheterization rooms, now known as hemodynamic laboratories, were then established.
International Recognition
In 1956, Werner Forssmann, André Cournand, and Dickinson Richards jointly received the Nobel Prize in Physiology or Medicine for their work, which profoundly transformed the understanding of the human heart.
Forssmann, once criticized for his daring, was ultimately acknowledged for a contribution described as monumental to medical science.
From Complications to New Solutions
The development of cardiac surgery eventually revealed several serious complications:
- cardiac conduction block,
- ventricular fibrillation,
- and preoperative diagnostic errors.
These challenges led to important advances, including:
- the invention of the pacemaker,
- the development of defibrillators,
- and the expansion of cardiac catheterization laboratories.
A Revolution Still in Progress
Cardiac catheterization made it possible to better understand heart malformations and the impact of surgical interventions on cardiac function.
However, at that time, it still did not allow visualization of the disease responsible for most cardiac deaths: coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease.
This limitation would, a few decades later, lead to the development of coronary angiography, a decisive step in the fight against heart disease.
Related articles
Latest articles
