The first cardiac catheter
2012; Elsevier BV; Volume: 59; Issue: 6 Linguagem: Inglês
10.1016/j.jvs.2012.06.086
ISSN1097-6809
Autores Tópico(s)Health and Medical Research Impacts
ResumoAlfred Nobel discovered dynamite and became one of the richest men in the world by manufacturing armaments. When a younger brother died in France in 1888, French newspapers mistakenly thought it was Alfred. Their headlines read “The Merchant of Death is Dead.” The papers declared that Alfred's powerful explosives killed more people, more efficiently, than ever before. The incident had a profound effect on him. He began thinking how he could leave a positive legacy. He was a complex person, who spoke six languages, wrote poetry, and was dismayed by the horror of war. After his death in 1896, his will created a foundation from his enormous estate that would bestow prizes to individuals who had achieved significant benefits for mankind. The fields of Medicine, Physics, Chemistry, Literature, and Peace were singled out. The Nobel Prize has become identified as the most coveted in the world. In 1956, the Prize in Medicine was awarded to the developers of cardiac catheterization, Drs André Cournand and Dickinson Richards from America and Dr Werner Forssmann from Germany. Who were these men, and what was their accomplishment? André Cournand (Fig 1) was born in Paris in 1895. From 1915 to 1918, he served in the French army during World War I. Resuming his studies, he graduated from medical school in 1925 and then spent 6 years working in pulmonary disease clinics. In 1931, he migrated to New York, having received an appointment as a resident in the Columbia's Chest Service at Bellevue Hospital. He was short, jovial, outgoing, and reminded me of a character in Agatha Christy's novels, Hercule Poirot. He made friends quickly; one was a senior fellow on his service, Dickinson Richards (Fig 2). Dickinson Richards was born in New Jersey in 1895. He graduated from Yale, and when the United States entered World War I, he volunteered in the army. He served as an artillery officer in France during 1917-1918. Returning from the war, resuming his studies, he graduated from Columbia's medical school in 1923. After several years of training on the Chest service at Bellevue he met André Cournand. Athletically built, he stood 6 feet 2 inches. His manner was quiet and introspective. Though different in appearance and personality from Cournand, they bonded immediately as close friends and worked productively as a team.1Richards D.W. Cournand A. Bryan N.A. Applicability of the rebreathing method for determining of mixed venous CO2 in cases of chronic pulmonary disease.J Clin Invest. 1935; 14: 173-180Crossref PubMed Google Scholar, 2Cournand A. Baldwin E.D. Darling R.C. Richards D.W. Studies on the intrapulmonary mixture of gasses IV. The significance of the pulmonary emptying rate and a simplified open-circuit measurement of residual air.J Clin Invest. 1941; 20: 681-689Crossref PubMed Google Scholar, 3Cournand A. Richards Jr, D.W. Pulmonary insufficiency 1 Discussion of a physiological classification and presentation of clinical tests.Am Rev Tuberc. 1941; 44: 26-41Google Scholar, 4Cournand A. Riley R.L. Bradley S.E. Breed E.S. Noble R.P. Lauson H.D. et al.Studies of the clinical circulation in clinical shock.Surgery. 1943; 13: 964-995Google Scholar, 5Darling R.C. Cournand A. Richards D.W. Domanski B. Studies on the intrapulmonary mixture of gases V. Forms of inadequate ventilation in normal and emphysematous lungs, analyzed by means of breathing pure oxygen.J Clin Invest. 1944; 23: 55-67Crossref PubMed Google Scholar In 1938, Cournand became an American citizen. In 1940, they read an intriguing article in an obscure German medical journal written 11 years previously by Werner Forssmann.6Forssmann W. [Probing of the right heart.].Klin Wochsenschr. 1929; 8: 2085-2087Google Scholar The subject was catheterization of the human heart. They realized the enormous potential of cardiac catheterization. Reading the paper changed their lives. In 1929, Werner Forssmann (Fig 3) was a general practitioner in a small town near Berlin. He was interested in the problems of heart diseases and speculated on the effectiveness of administering digitalis directly into the heart. Operating on a dog, he inserted a urological catheter through a leg vein into the right atrium. The dog survived. He became obsessed with the idea of doing the same thing on a human, but his colleagues at his hospital thought his idea was insane. They forbade him to do the experiment on a person. He determined to perform heart catheterization on himself and convinced the operating room nurse at the hospital to cooperate with him. She agreed, but with the stipulation that he would catheterize her, not himself. One Sunday, he went through the motions of starting the procedure on her. Instead, he isolated his own left antecubital vein and threaded the catheter into his upper chest. He then told the nurse what he had done and asked her to call an X-ray technician to the X-ray room. They walked down two flights of stairs to the X-ray department, and, once there, he advanced the catheter a total of 65 cm from the elbow. An X-ray showed the catheter well into his heart. There were no ill effects, and the catheter was removed. A short report was made.6Forssmann W. [Probing of the right heart.].Klin Wochsenschr. 1929; 8: 2085-2087Google Scholar Forssmann did not follow up on his experiment. In 1932, he joined the Nazi party and remained a member until 1945. Cournand and Richards planned to follow-up on Forssmann's idea but our entry into World War II made them postpone their plans. They worked on the problem of traumatic shock4Cournand A. Riley R.L. Bradley S.E. Breed E.S. Noble R.P. Lauson H.D. et al.Studies of the clinical circulation in clinical shock.Surgery. 1943; 13: 964-995Google Scholar with relevance to the war effort. In 1945, they confirmed Forssmann's experiment and opened a cardiac catheterization laboratory at Bellevue Hospital. It was an immediate success. Details of heart and lung dysfunction were disclosed and many publications were written.7Richards D.W. Cardiac output by the catheterization technique in various clinical conditions.Fed Proc. 1945; 4: 215-220Google Scholar, 8Baldwin E.D. Moore L.V. Noble R.P. The demonstration of ventricular septal defect by means of right heart catheterization.Am Heart J. 1946; 32: 152-162Abstract Full Text PDF PubMed Scopus (7) Google Scholar, 9Dexter L. Haynes F.W. Burwell C.S. Eppinger E.C. Sosman M.C. Evans J.M. Studies of congenital heart disease. II. Venous catheterization as a diagnostic aid in patent ductus arteriosus, tetralogy of Fallot, ventricular septal defect, and auricular septal defect.J Clin Invest. 1947; 26: 561-576Crossref Scopus (6) Google Scholar, 10Cournand A. Baldwin J.S. Himmelstein A. Cardiac catheterization in congenital heart disease. Commonwealth Fund, New York1949Google Scholar In 1948, Dr John R. West became an invaluable member of the team. A brilliant researcher, he designed and constructed most of the recording equipment in the laboratory. In 1951, a second laboratory was opened at Presbyterian Hospital, directed by Dr West. In 1951, I was in the second year of a 5-year appointment as a surgical resident at Columbia-Presbyterian Hospital. It was a period designated for research. Afternoons were spent in the experimental surgical area testing a plastic replacement for the aorta.11Levin S.M. Breakthrough: Arthur Blakemore and Arthur Voorhees, Jr..J Vasc Surg. 2012; 55: 1829-1831Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar I was interviewed by Dr West and gained the assignment to work mornings in his laboratory. My time in the laboratory was a marvelous learning experience with Dr West, who was charismatic and passionate about his work. I learned to use the catheters, perform arterial punctures, use a fluoroscope, and analyze pulmonary function data. I co-wrote a paper with him,12West J.R. Levin S.M. Di Sant'Agnese P.A. Pulmonary function in cystic fibrosis of the pancreas.Pediatrics. 1954; 13: 155-164PubMed Google Scholar my first. Biweekly cath laboratory rounds were conducted by Drs Cournand, Richards, and West in the large medical school auditorium. They were very popular with students, house staff, and attending staff. These sessions were standing room only. Early in 1954, we were devastated to learn that Dr John West was diagnosed with leukemia. In June, at age 37, he died of a cerebral hemorrhage. Dr Richards wrote a touching obituary, stressing a great scientific potential that would never be fully realized. The great contribution to humanity made by the “cath lab” was recognized in 1956 when the Nobel Prize in medicine was awarded to Drs Cournand, Richards, and Forssmann. I was in Scandinavia on a surgical fellowship when I learned of the award. I wrote a letter of congratulations to them and received a cordial letter from Dr Richards. Through a remarkable chain of events, my wife and I were able to attend the awards ceremony in Stockholm and to cheer loudly for them. It was an unforgettable evening. White tie, tails, ribbons for the men, evening gowns, and jewels for the women. The walls of the opera house were covered with blue and yellow flowers, colors of the Swedish flag. The king of Sweden spoke to each recipient in French and English. After each presentation, the full orchestra played a short piece. It was a spectacular production, an once-in-a-lifetime occasion. The following day, the three medalists in medicine gave talks at the Carolinske Institute. It was marvelous to greet Drs Cournand and Richards. They were surprised and happy to see me. The joy of the occasion was dampened by the absence of Dr West. All of the Nobel Prizes in Medicine recognized gifts to mankind. No contribution has been greater than the development of the “cath labs.” Catheterization of the right heart led to study of the left heart and to coronary arteriography. Disclosure of threatening foci of narrowed arteries led to coronary artery dilatations and stenting and to coronary artery bypass grafting. Millions of lives have been saved and extended worldwide by these therapies, made possible by cardiac catheterization. It was a privilege to have known Drs Cournand, Richards, and West personally and to have been taught by these remarkable men. It is fitting to recall the contribution of Dr John Robert West III to cardiac catheterization.13Richards D.W. In Memoriam, John Roberts West III. Yearbook Archives College of Physicians & Surgeons. Columbia University, New York1955http://www.archive.org/stream/psyearbookofcoll1955colu/psyearbookofcoll1955colu_djvu.txtGoogle Scholar
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