Discovery Of Cardiac Catheterization

How a self-surgery led to breakthrough procedure?

Almost everyone knows someone in there near or distant relation with a cardiac illness or more commonly “heart disease”. With increasing awareness of common health issues among individuals and access to information available on internet, almost everyone know about heart attack, heart failure, angiography or angioplasty and other similar procedures.

Cardiac catheterization is the process of passing a narrow tube through any vein into the heart chambers. This technique is a necessary part of various diagnostic and surgical procedures. The technique was first demonstrated by a German physician Werner Forssmann. The story behind his discovery is quite interesting. He got this idea from a picture in his physiology book. It was a sketch showing a thin tube inserted into jugular vein (one of the large blood vessels in neck) of a horse, with a balloon attached at other end. This was used for measuring the pressures inside heart. Forssmann proposed that similar technique can be used in human through accessing vessels on arm.

The issue was to test this technique, as human experimentation is associated with many ethical, moral and legal questions. He was so obsessed with the idea that he convinced one of nurses at Augusta Victoria Hospital to volunteer for experiment. This was because she had access to surgical instrument and catheter that was required for this procedure. After preparing and strapping the nurse to the operating table, he first pretended to reach her for making incision for the process. What he did next was both unexpected and questionable.

He applied local anesthetic on his vein and made an incision for the tube.

After that, he inserted the tube and advanced it up the arm. After which the nurse realized what actually happened. He rushed to the X-ray room with tube inserted in his arm for confirming the location of catheter. During this, one of fellow doctor who noticed him, tried to stop him, but he insisted to continue. After the imaging showed that his catheter has reached shoulder level, he advanced further. He felt warmth along the tube but it was painless. At one point he also felt an urge to cough as the tube hit one of the walls of vein near the neck. He advanced, and as x-ray showed that the tube has reached the right atrium (right upper chamber of heart), he asked the X-ray nurse to take images. The tube was 65 cm, which means that he inserted almost 2 feet inside his blood vessels and was stable.

The reaction of the medical community was not very positive. He wrote about the details of his experiment in an article which was published in a journal in 1929. His fellow doctors, hospital, and other people criticized him, despite of the achievement that could serve as milestone in medical field. He was dismissed from his duties, which made him very disappointed. He left his career in cardiology, as could not find any reputable position in surgery and started working as an army medical officer. During WWII, he was taken as a prisoner by allies.  After the war ended, he was released but did not start working as a doctor.

After many years of his exile from medical field, his article was found by two American physicians working in the cardiac surgery. They realized the significance of his work and after much study and research they developed catheterization as safe, standard and lifesaving technique for many heart conditions. In 1956, he was awarded Nobel Prize in Medicine along with Andre Cournand and Dickinson Richard for discovering such an effective technique. The procedure is used for diagnosis of heart vessel blockage, narrowing, hardening, measuring pressures, valve repair and treating many heart issues.

He is regarded as founder of cardiac catheterization. He was offered position of professor in cardiology but refused due to his lack of updated knowledge as he as remained out of the field for many years. He felt accomplished as well as disheartened on receiving the news that he was awarded. According to him, he felt like others have harvested from the plantation for which he planted seeds. In an interview he said, “I feel like a village person who has just learned that he has been made bishop”. No wonder, what he could have achieved if he continued to work in this field.

Ahsan Zaheer

Trying to be human.

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