Brief History of Cardiac Catheterisation

Brief History of Brief History of Cardiac Cardiac

Catheterisation Catheterisation

Gemma C. RyderGemma C. [email protected]@qmul.ac.uk

Intra-cardiac catheterIntra-cardiac catheter

A thin tube passed to the heart via a vein or A thin tube passed to the heart via a vein or arteryartery Used to withdraw bloodUsed to withdraw blood Measure pressure in heart chambers or great Measure pressure in heart chambers or great

vesselsvessels Inject contrast mediaInject contrast media

For diagnosis and evaluation of congenital conditions For diagnosis and evaluation of congenital conditions and coronary artery lesionsand coronary artery lesions

To evaluate systolic and diastolic cardiac functionTo evaluate systolic and diastolic cardiac function

4 Major Events in CC History4 Major Events in CC History

Development of techniques for measuring Development of techniques for measuring intracardiac physiologic events in animals intracardiac physiologic events in animals

Application of these techniques to Application of these techniques to humanshumans

Development of coronary angiography Development of coronary angiography Development of catheter-based Development of catheter-based

proceduresprocedures

Early catheterisation 1Early catheterisation 1

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

Early catheterisation 2Early catheterisation 2

In 1844, Claude Bernard inserted a mercury In 1844, Claude Bernard inserted a mercury thermometer into a horse carotid arterythermometer into a horse carotid artery

Early chemotherapy required the Early chemotherapy required the injection of drugs directly into the injection of drugs directly into the central circulation. Bleichroeder central circulation. Bleichroeder inserted catheters into dog arteries and inserted catheters into dog arteries and assessed the effects after leaving them assessed the effects after leaving them in place for several hours. He reported in place for several hours. He reported no complications or clots. no complications or clots.

First catheterisation in a First catheterisation in a humanhuman

In 1929, a German surgical In 1929, a German surgical trainee, Werner Forssmann, trainee, Werner Forssmann, experimented on a human experimented on a human cadaver and realized how cadaver and realized how easy it was to guide a easy it was to guide a urological catheter from an urological catheter from an arm vein into the right atrium arm vein into the right atrium

•In the early 1940's, Cournand, working in New York,began utilizingIn the early 1940's, Cournand, working in New York,began utilizingright heart catheterisation on a regular basis in the undertaking of aright heart catheterisation on a regular basis in the undertaking of acomprehensive investigation of cardiac function in both normal andcomprehensive investigation of cardiac function in both normal anddiseased patientsdiseased patients

Development of Development of catheterisationcatheterisation

1953 Seldinger developed a 1953 Seldinger developed a percutaneouspercutaneous approach for the introduction of catheters for approach for the introduction of catheters for both right and left heart catheterisationboth right and left heart catheterisation

In the 1950's, diagnostic catheterisation In the 1950's, diagnostic catheterisation became established as the best method for became established as the best method for confirmation of clinical findings prior to confirmation of clinical findings prior to cardiac surgery for valvular or congenital cardiac surgery for valvular or congenital heart disease. heart disease.

Vascular AccessVascular Access

Prior to Seldinger – vascular access via Prior to Seldinger – vascular access via cutdowncutdown

ComplicationsComplications HaemorrhageHaemorrhage InfectionInfection Acute thrombosisAcute thrombosis Distal embolisationDistal embolisation

Cut DownCut Down

Seldinger TechniqueSeldinger Technique

Inject local anaestheticInject local anaesthetic Locate arteryLocate artery Puncture with 18G needle Puncture with 18G needle Advance guidewire thru’ into arteryAdvance guidewire thru’ into artery Remove needle and advance introducer Remove needle and advance introducer

sheathsheath



Complications of Seldinger Complications of Seldinger TechniqueTechnique

HaemorrhageHaemorrhage AV fistulaAV fistula DissectionDissection Embolism/ThrombosisEmbolism/Thrombosis Closure Closure

Manual compressionManual compression Closure devicesClosure devices

Closure DeviceClosure Device

Closure Device 2Closure Device 2

Complications of Complications of CatheterisationCatheterisation

ThrombosisThrombosis Extrinsic - catheter materialExtrinsic - catheter material

HeparinHeparin PTFE, coatingsPTFE, coatings

Intrinsic - endothelial damageIntrinsic - endothelial damage Catheter designCatheter design

Coronary AngiographyCoronary Angiography

1958 Accidental discovery by Sones1958 Accidental discovery by Sones Involves injecting contrast agent into the Involves injecting contrast agent into the

coronary arteriescoronary arteries Cine-angiography Cine-angiography

X-ray images taken in rapid succession to X-ray images taken in rapid succession to capture the dye’s progression capture the dye’s progression



Angiography Video 1Angiography Video 1

Angiography Video 2Angiography Video 2


Catheter-based proceduresCatheter-based procedures

Valvuloplasty – to open stenotic valvesValvuloplasty – to open stenotic valves Pacemaker implantationPacemaker implantation Angioplasty 1974 peripheral/1977 Angioplasty 1974 peripheral/1977

coronarycoronary AtherectomyAtherectomy LasersLasers StentsStents

Catheter based interventions Catheter based interventions are now very common…are now very common…

19971997 — over one million angioplasties — over one million angioplasties performed worldwide, making angioplasty the performed worldwide, making angioplasty the most common medical intervention in the most common medical intervention in the world world

20012001 — almost two million angioplasties were — almost two million angioplasties were performed worldwide, with an estimated performed worldwide, with an estimated increase of 8% annually increase of 8% annually

20022002 — the 25th anniversary of the first — the 25th anniversary of the first angioplasty performed in an awake patient angioplasty performed in an awake patient

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Brief History of Cardiac Catheterisation