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IN THE BEGINNING

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In 1929, a 25-year-old intern named Werner Forssman was dissatisfied with the available methods of evaluating cardiac function at his hospital in Berlin. His appeals to his supervising physicians for permission to test a cardiac catheterization technique he had envisioned were flatly denied. Secretly, Forssman enlisted the help of a nurse and conducted the experiment on himself. Threading a rubber catheter through a vein in his left arm to the level of his heart and injecting dye, Forssman completed the first successful cardiac catheterization. Upon discovery of his experiment, he was promptly fired from his job and ostracized by the medical community. It was not until 27 years later, in 1956, that Forssman was awarded the Nobel Prize in physiology and medicine for his achievement.

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Several other great medical inventions made their debut around the time Forssman received the Nobel Prize. John Gibbons revealed his heart–lung machine, and Michael Debaky successfully performed open heart surgery and created the artificial arterial conduit Dacron. The field of cardiovascular surgery was at the forefront of new medical technologies. During the same period, when the medical community was enchanted with open surgery, minimally invasive techniques were quietly being developed.

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In 1953, a 32-year-old Swedish radiologist named Sven Seldinger developed a percutaneous technique in which a wire, threaded through a needle into a vessel, is exchanged for a catheter. The "Seldinger technique" is ubiquitous in medicine today and makes a surgical incision unnecessary for catheter-based therapies. Another important, although less well-known, contribution of Seldinger's was the design of a U-shaped catheter tip for selective catheterizations. By placing a wire through a straight catheter and bending both together over the steam of a coffee pot before cooling them rapidly, Seldinger fabricated a bent tipped catheter that could be straightened by advancing the wire through the lumen. This model, common today, makes selective arterial catheterization feasible for physicians of average dexterity. The Seldinger technique was widely practiced in Sweden soon after its description, but it took more than a decade and the endorsement by radiologist Charles Dotter from the University Of Oregon Health Sciences for the technique to catch on in the United States.

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A SWITCH TO INTERVENTIONS

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In 1958, Mason Sones, a pediatric cardiologist at the Cleveland Clinic, made a landmark discovery. At that time, the current practice for obtaining coronary angiograms involved a large-volume contrast injection into the aortic arch to opacify the coronary arteries. It was thought that selectively coronary cannulation would cause fatal arrhythmias. While attempting a left ventricular image, Sones inadvertently cannulated the right coronary and produced a selective arteriogram with 30 cc of Hypaque contrast. Initially horrified, when the patient suffered only a transient rhythm disturbance and recovered quickly, Sones realized that selective coronary angiography could be tolerated. In 1962, he published his technique of slowly hand injecting 3 to 6 cc of contrast and using an image ...

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