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A short history of cardiac catheterization

Cardiac catheterization started in the 1800s in the search for understanding cardiac physiology. In 1844 Claude Bernard performed a cardiac catheterization of a horse, putting a catheter in both the right and left ventricles via the jugular vein and the carotid artery respectively. The first known human catheterization didn't occur until 1929 when Werner Forssmann stuck a catheter into his own left antecubital vein and threaded it up into his right atrium while watching a fluoroscopy screen to guide it. He then walked up a flight of stairs to the x-ray department and took a chest x-ray to document the procedure. He apparently suffered no ill effects and continued to experiement with catheterizing himself for a time. In 1956 he shared a nobel prize in medicine with other contributers in the field. Early investigators used cardiac catheterization to understand cardiac physiology by directly measuring pressure waveforms in the living heart, sampling blood for analysis, and developing ways to calculate the cardiac output, a key parameter for characterizing heart function. Modern techniques of intervention depended on the developement of retrograde catheterization of the arterial system in 1950 by Zimmerman, Limon-Lason, and Bouchard; and the technique of entering thru the skin rather than a surgical cutdown, by Seldinger in 1953. The developement of catheters to selectively engage individual arteries was by Sones and others in 1959. Standard shapes and techniques for catheters inserted percutainiously were further developed by Ricketts, Adams, in 1962, and by Judkins in 1967. Completing the basic modern equipment was the development of the practical balloon tipped flow guided catheter in 1970 by Swan and Ganz, so that pressures on the right side of the heart could be easily measured and the pressures on the left side of the heart estimated via a pulmonary wedge pressure, without actually entering the left side chambers. The use of these techniques was originally to diagnose heart disease, and document the distribution and severity of blocked arteries. The patient would still be treated by medicines and surgery. The modern use of catheters to treat cardiac disease started in 1977 when Gruntzig introduced balloon angioplasty to modify coronary artery plaque. The use of plain balloon angioplasty to modify coronary artery plaqus suffers from several drawbacks, including the tendancy of the vessel to recoil and reoclude the vessel. The use of stents, a thin metal scaffolding to support the vessel, was developed in animal research during the 1980's and first used in human trials in a report published by Sigwart and colleagues in 1987.