When I wrote the story of Werner Forssmann catheterizing of his own heart, I ignored my more personal debt to Forssmann’s striking accomplishment. That personal debt was sparked some years ago, on one sunny morning as I tramped up a long hill. The hill was familiar, but what happened that morning was not. As I neared the crest of that hill, a vague sensation eased into my chest. I took note of it, and walked on.
The next morning I challenged that same hill, and again felt an identical sensation as I approached the top. For lack of a better description, it was a feathery touch of fullness beneath the upper part of my breast bone. Nothing else. No pain. No pressure. Just a fleeting sensation before topping the hill. Most individuals, had they noticed it at all, most likely would have ignored it, but I had spent countless hours on hospital cardiac wards. I knew how subtle the heart’s signals can be.
So I made an appointment to see my cardiologist. He listened, nodded, and recommended a thallium scan of my heart. That scan revealed that blood flowing to parts of my ventricles was limited during a stress test, a finding that earned me a trip to a local hospital for a coronary arteriogram.
Much had changed, of course, since Forssmann’s time. Scientific advancements and amazing technical developments have changed the game entirely. For my catheterization, I was wheeled into a laboratory on a Gurney and scooched onto an examination table. The target of the day was not the right side of my heart, the side that had been Forssmann’s goal, but rather the left side, the high pressure side, and its arteries.
I felt a faint pinprick in my groin as local anesthetic was injected in the skin above my right femoral artery, but no other sensation as a catheter was threaded into that artery through a needle and pushed up my aorta to my heart. Like Werner Forssmann, I felt very little during this probing of my heart.
From my supine position, I watched the movable part of the large recording instrument swing above me, and I obediently turned my head to the left as instructed, then to the right, so the huge apparatus would clear my nose as it slid back and forth only centimeters above me. I heard an occasional whirring sound as 35mm film sped through its sockets.
“You’ll feel a little warmth,” the cardiologist said as he injected dye into my coronary arteries, and I did, a not unpleasant stream of warmth spreading through my chest. That was all I felt. Nothing more. Unlike Forssmann, I felt no urge to cough.
The results were as I anticipated. Films of my dye-filled left coronary artery revealed significant narrowing in two of its branches, a discovery that kept me in the hospital that night, in preparation for my treatment on the following day.
My second trip to the cath lab was also painless. I again felt the pinprick in my skin, and then the warmth of injected dye. But I felt nothing during the actual treatment as a catheter was wedged into my left coronary artery. On the tip of that catheter was an inflatable balloon covered with a stent. When the tip was wedged into a narrowed segment of my artery, the balloon was inflated. This expanded the mesh-like metal of the stent, forcing my narrowed segment to open wider, and also preventing it from collapsing. Following this brief procedure, performed on both of my narrowed segments, I was wheeled back to the recovery room and later given dinner.
My cardiologist checked me out the next morning. All was well, and he discharged me from the hospital, mission accomplished. Unlike Forssmann, I had no inflammation at the site puncture, just the anticipated bruise where blood had leaked into my inner thigh during the procedures, the consequence of anticoagulants given to prevent my blood from clotting as it flowed through my newly stented arteries.
A few days after this procedure, I retested the hill that had put me on alert. I kept a steady pace as I tramped up that long slope and happily felt no feathery sensation in my chest as I cruised to the top. It was then, not surprisingly, that my thoughts slipped back to Werner Forssmann, the guy who had blazed this amazing trail. Following his lead, countless clinicians have fine-tuned his technique and made dozens of other critical advances, but it was Forssmann who opened the door.
I’m told one million cardiac catheterizations are performed worldwide each year, an astonishing development that the young German surgeon in 1929 could never have envisioned. At dinner tonight, being merely one of the myriad of men and women benefitting from his bravery, I shall lift a glass in tribute to Werner Forssmann, the man who started it all over ninety years ago.
