Venous Catheterization of the Heart

Werner Forssman (10, 11) was the first to pass a catheter into the heart of a living patient, doing it first on himself, with the help of a surgical colleague who made the incision over the median basilic vein in the antecubital space. Others (13, 14) subsequently used the same technic for various purposes, and some of our radiological colleagues attempted visualization of the cardiac chambers and pulmonary arteries by this means (2). The lumen of the catheter, however, was too small to permit rapid filling of the chambers with radiopaque material, and the introduction of the Robb-Steinberg technic of angiocardiography (15) has made catheterization of the heart unnecessary for that purpose. Cournand and Ranges (3, 4) and their associates have used the method more than any group in this country, largely in the study of cardiovascular dynamics, particularly in shock. Their report in 1941 stimulated others to use the venous catheter, and at the present time a considerable literature has accumulated on the subject. Cournand (5), in 1945, reported 1,200 such examinations with no fatalities and no serious complications from the passage of the catheter. However, we know of one death in another institution following the injection of diodrast through the catheter in a patient who had been injected with the same medium ten days before (16). Fluoroscopy is an essential part of the procedure; yet we could find but one paper in the American radiological journals, that of Conte and Costa in Radiology, 1933 (2), mentioning the use of the right heart catheter for the purpose of better visualization of the pulmonary arteries. Most of the reports have been concerned with research problems and clinical investigations, but there are practical useful applications, particularly in the study of congenital heart disease, which we wish to emphasize. Indications Catheterization of the right heart is most useful in the study of hemodynamics, both in establishing the normals for physiological variations and the changes in the varied forms of heart failure, cardiopulmonary disease, and shock. It is valuable, also, in helping to establish the diagnosis more accurately in congenital heart disease. In addition, the method has been used in the study of cerebral, renal, and hepatic physiology in health and disease, by the collection of samples of blood from the jugular (Fig. 1, A), renal, or hepatic veins as desired. In our series, the first 100 such examinations were done for the following purposes: The first such examination at the Peter Bent Brigham Hospital was done on Nov. 8, 1944, and the one-hundredth on Nov. 13, 1946.