Surveying the landscape of interventional cardiology today, one sees a mature discipline using sophisticated technology and techniques that are backed by the findings of rigorous clinical trials. Many advancements have occurred in the field since the first angioplasty performed by Andreas Gruentzig in 1977. What began as a technique to treat a focal stenosis in patients with stable angina by physicians who performed diagnostic cardiac catheterizations has progressed to complex percutaneous interventions in unstable patients by highly trained and experienced operators. The work in coronary interventions also served as a catalyst for the development of therapies and technology to treat valvular heart disease with percutaneous valve replacement and repair. Understanding the history and development of interventional cardiology provides important insight and perspective to appreciate current practices as well as provide inspiration for future advancement of the field.
EARLY DEVELOPMENTS IN INVASIVE CARDIOLOGY
Many individual achievements provided the foundation for the development of interventional cardiology (Fig. 1-1). Werner Forssmann is credited as performing the first human cardiac catheterization in 1929 while working in Eberswalde, Germany.1 He was inspired by the works of French physiologists Bernard, Chauveau, and Marey, who measured the intracardiac pressures in horses by directly inserting catheters into the heart. He hypothesized that accessing the heart directly with a catheter would provide a safer mechanism to deliver therapeutic drugs. Unfortunately, he did not have the support of his department chief, who thought such a procedure was reckless and likely fatal. Despite his chief’s disapproval, he was unrelenting in his pursuit and decided to perform the procedure on himself. With the help of a unsuspecting nurse, he cut down to his left brachial vein and inserted a urinary catheter as far as it would go.
Innovations in the field of catheter-based treatment of atherosclerosis.
He then traveled with the nurse to the basement where the x-ray machine was located and documented the catheter location in the right atrium. His self-experimentation resulted in disciplinary action, and as a result, Forssmann was not able to pursue any further study on the subject.2
Much of the development of right heart catheterization and hemodynamic assessment is credited to the work of Andre Cournand and Dickson Richards at Bellevue Hospital in New York, which resulted in a 1956 Nobel Prize in Medicine that was shared with Forssmann.
Refinements in right heart catheterization over the next 2 decades eventually led to the desire to better understand left heart hemodynamics and valvular function through catheterization. After working out much of the details of accessing the left ventricle in a canine model, Henry Zimmerman performed the first left heart catheterization on a human in 1950 via a radial artery approach in Cleveland, Ohio.3 Early left heart catheterizations consisted of hemodynamic assessments and ...