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May 27, 2017
Cardiac Catheterization Henry Zimmerman

Henry Zimmerman (1915-2007)

Zimmerman HA, Scott RW, Becker NO. Catheterization of the left side of the heart in man. Circulation 1950;1:357-9



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Henry Zimmerman and his colleagues performed the first left heart catheterization in 1950. The ulnar artery was selected for the introduction of the catheter and exposed after a small incision. A 6F catheter was advanced retrogradly to the ascending aorta and the left ventricle. They were able to reach the left ventricular cavity in eleven patients with syphilitic aortic insufficiency with no complications.

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Ventricular fibrillation occurred in one patient with rheumatic aortic regurgitation during the passage of the catheter into the left ventricle. Despite aggressive resuscitation, this patient did not survive. In this early experience, the authors also reported 3 cases in which they failed to pass the catheter from the aortic orifice into the left ventricle.


Another group led by Limon-Lason also reported their attempts at left heart catheterization using a retrograde approach in 1950.


Following Zimmerman's report, the retrograde approach requiring crossing the aortic valve was considered too hazardous and several alternative approaches via the left atrium were described.


In 1952, Facquet described a needle puncture of the left atrium through a bronchoscope.  In 1953, Bjork proposed needle puncture of the left atrium through the chest wall for pressure measurement. Finally, Radner suggested a suprasternal approach to measure left atrial pressure.  Although these methods were applied for the diagnosis of cardiac diseases, they were complex and associated with certain procedural-related complications.  The latter led several investigators to reconsider the retrograde approach.


In 1953, Sven Seldinger described a percutaneous technique using a retrograde approach. Obviously, the major advantage of this technique was that it did not require an incision to expose the artery.  Using this modality, first a needle puncture of the artery was performed. A flexible wire was then inserted into the artery through the needle and finally the catheter was advanced over the wire. In early 1960's, with technological advances, the Seldinger technique became the preferred approach for cardiac catheterization and direct puncture of cardiac chambers for hemodynamic measurement was progressively abandoned.

 

REFERENCES

Limon-Lason R, Bouchard A. El catetersimo intracardico: cateterizacion de las cavidades iz quierdas en el hombre. Registro simultaneo de presion y electrocardiograma intracavetarios. Arch Inst Cardiol Mexico 1950;21:271-85

Facquet J, Lemoine C, Alhomme P, Lefebrie J. La mesure de la pression auriculaire gauche par voie transbronchique. Arch Mal Coeur 1952;45:741-5

Bjork VO, Malmstrom G, Uggla LG. Left auricular pressure measurement in man. Ann Surg 1953;138: 718

Bjork VO, Blakemore WS, Malmstrom G. Left ventricular pressure measurement in man: new method. Am Heart J 1954; 48:197-203

Radner S. Suprasternal puncture of the left atrium for flow studies. Act Med Scand 1954;148:57-60

Seldinger SI. Catheter replacement of needle in percutaneous arteriography: new technique. Acta Radiol 1953;39:368-76


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