The field of interventional cardiology has been driven by technical innovation. In a remarkable progression of needs identification, invention, testing, and refinement, innovators have developed nonsurgical techniques to see into the heart, diagnose a wide array of conditions, and deliver potent therapies. The pathways to innovation were not always simple or straightforward. Many of these inventors persevered despite being told by peers that what they were trying to do was infeasible and foolhardy. Some of most momentous contributions came from innovators who recognized the significance of a serendipitous event, applied newly available technologies to a longstanding clinical need, maximized the value of a previous discovery by casting it in a different light, or refined nascent tools and techniques to make them safer and more effective. Collectively, the efforts of these creative, determined individuals laid the foundations of a dynamic field that integrates diagnostics with the minimally invasive treatment of ischemic heart disease and other cardiac conditions.
One of the earliest pioneers of cardiac catheterization, Werner Forssmann, was a German surgical resident who saw the need for a safer, more direct way to deliver drugs to the heart for cardiac resuscitation. He was interested in accessing the right heart via the venous system, but was not permitted to conduct a study because of the prevailing certainty that any foreign penetration of the heart would be instantaneously fatal. However, Forssmann was familiar with previous catheter experiments on animals, as well as accounts of accidental incursions in which the patients had survived.1 In 1929, he threaded a urethral catheter into his own right atrium via his left antecubital vein and documented the catheter position by x-ray. Although the significance of his achievement was recognized by some, its merit was overshadowed by the consensus that his work was unacceptably dangerous. While Forssmann initially persisted in his research, the condemnation of his peers and loss of several academic positions caused him to abandon cardiology.2,3
Years later, building on Forssmann’s work, André Cournand and Dickinson Richards went on to routinely catheterize both the right heart and the pulmonary artery, establishing the safety of the procedure in association with their groundbreaking research into cardiopulmonary physiology. By analyzing blood taken from the heart via a catheter, Cournand and Richards were able to detect hemodynamic abnormalities characteristic of congenital heart disease and pulmonary heart disease, measure the actions of cardiac drugs, perform studies of traumatic shock, and explore the physiology of heart failure.4 For this research, they were awarded the Nobel Prize in 1956, which they shared with Forssmann.3 Notably, while Forssmann was reportedly trying to develop a therapeutic technique, the essential advancements in the understanding of right heart physiology and pulmonary blood flow that followed came from innovators who focused on catheterization as a diagnostic tool.