Brief History of Cardiac Catheterisation Gemma C. Ryder [email protected]
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
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
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.
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.
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 acomprehensive investigation of cardiac function in both normal and diseased patients
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.
Vascular Access Prior to Seldinger vascular access via cutdown Complications Haemorrhage Infection Acute thrombosis Distal embolisation
Seldinger Technique Inject local anaesthetic Locate artery Puncture with 18G needle Advance guidewire thru into artery Remove needle and advance introducer sheath
Complications of Seldinger Technique Haemorrhage AV fistula Dissection Embolism/Thrombosis Closure Manual compression Closure devices
Closure Device 2
Complications of Catheterisation Thrombosis Extrinsic – catheter material Heparin PTFE, coatings Intrinsic – endothelial damage Catheter design
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
Angiography Video 1
Angiography Video 2
Catheter-based procedures Valvuloplasty to open stenotic valves Pacemaker implantation Angioplasty 1974 peripheral/1977 coronary Atherectomy Lasers Stents
Catheter based interventions are now very common 1997 over one mil ion angioplasties performed worldwide, making angioplasty the most common medical intervention in the world 2001 almost two mil ion angioplasties were performed worldwide, with an estimated increase of 8% annual y 2002 the 25th anniversary of the first angioplasty performed in an awake patient