Brief History of Cardiac Catheterisation

1. Brief History of Cardiac Catheterisation Gemma C. Ryder g.c.ryder@qmul.ac.uk

2. Intra-cardiac catheter • A thin tube passed to the heart via a vein or artery • Used to withdraw blood • Measure pressure in heart chambers or great vessels • Inject contrast media • For diagnosis and evaluation of congenital conditions and coronary artery lesions • To evaluate systolic and diastolic cardiac function

3. 4 Major Events in CC History • Development of techniques for measuring intracardiac physiologic events in animals • Application of these techniques to humans • Development of coronary angiography • Development of catheter-based procedures

4. Early catheterisation 1 •  In 1711, Stephen Hales conducted the first cardiac catheterisation of a horse using brass pipes, a glass tube and the trachea of a goose.

5. Early catheterisation 2 •  In 1844, Claude Bernard inserted a mercury thermometer into a horse carotid artery • Early chemotherapy required the injection of drugs directly into the central circulation. Bleichroeder inserted catheters into dog arteries and assessed the effects after leaving them in place for several hours. He reported no complications or clots.

6. First catheterisation in a human • In 1929, a German surgical trainee, Werner Forssmann, experimented on a human cadaver and realized how easy it was to guide a urological catheter from an arm vein into the right atrium • In the early 1940's, Cournand, working in New York,began utilizing • right heart catheterisation on a regular basis in the undertaking of a • comprehensive investigation of cardiac function in both normal and • diseased patients

7. Development of catheterisation • 1953 Seldinger developed a percutaneous approach for the introduction of catheters for both right and left heart catheterisation • In the 1950's, diagnostic catheterisation became established as the best method for confirmation of clinical findings prior to cardiac surgery for valvular or congenital heart disease.

8. Vascular Access • Prior to Seldinger – vascular access via cutdown • Complications • Haemorrhage • Infection • Acute thrombosis • Distal embolisation

9. Cut Down

10. Seldinger Technique • Inject local anaesthetic • Locate artery • Puncture with 18G needle • Advance guidewire thru’ into artery • Remove needle and advance introducer sheath

11. Seldinger Technique

12. Seldinger Technique

13. Complications of Seldinger Technique • Haemorrhage • AV fistula • Dissection • Embolism/Thrombosis • Closure • Manual compression • Closure devices

14. Closure Device

15. Closure Device 2

16. Complications of Catheterisation • Thrombosis • Extrinsic - catheter material • Heparin • PTFE, coatings • Intrinsic - endothelial damage • Catheter design

17. Coronary Angiography • 1958 Accidental discovery by Sones • Involves injecting contrast agent into the coronary arteries • Cine-angiography • X-ray images taken in rapid succession to capture the dye’s progression

18. Coronary Angiography

19. Coronary Angiography

20. Angiography Video 1

21. Angiography Video 2

22. Coronary Angiography

23. Catheter-based procedures • Valvuloplasty – to open stenotic valves • Pacemaker implantation • Angioplasty 1974 peripheral/1977 coronary • Atherectomy • Lasers • Stents

24. Catheter based interventions are now very common… • 1997 — over one million angioplasties performed worldwide, making angioplasty the most common medical intervention in the world • 2001 — almost two million angioplasties were performed worldwide, with an estimated increase of 8% annually • 2002 — the 25th anniversary of the first angioplasty performed in an awake patient