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Our nation's highest death rate gives evidence of the failure of traditional therapeutic methods in arteriosclerotic heart disease. In 1959, the disease will take the lives of over a half-million Americans. The lesion which each year is directly responsible for 400 times as many deaths as poliomyelitis is a localized narrowing confined to the proximal divisions of the left coronary artery. We believe that a direct surgical attack constitutes the most logical approach to this essentially mechanical obstruction to myocardial blood flow. If so, it will be necessary to obtain detailed anatomical information concerning the extent and location of disease in order to select patients for surgery, plan the operative approach, and evaluate the results. This report describes a technic for coronary angiography which has been found to be safe and reliable in the dog. We believe it is ready for application to the study of the diseased coronary arteries of man. In this procedure, a special double-lumen balloon catheter is used to inject a contrast substance into the proximal aorta during a period of brief but total occlusion of the ascending aorta just above the site of injection. There being no alternative, all of the contrast substance enters the coronary arteries, thereby allowing their radiographic visualization with maximum efficiency. Coronary Visualization: Background As far as we have been able to determine, the first in vivo contrast studies of coronary arteries were reported by Peter Rousthöi (1) and, independently, by Reboul and Racine (2). Rousthöi's brief but classic article not only described coronary arteriography but also cardiac ventriculography, thoracic aortography, and aortic valvulography. He successfully employed several technics which were subsequently “discovered” by others, including catheterization of the thoracic aorta via peripheral arteries, catheterization of the left ventricle via the aorta, direct needle puncture of the thoracic aorta, and direct needle puncture of the left ventricle. Thus, by the end of 1933, these workers and others had established experimental or clinical precedent for virtually all of today's contrast cardiovascular technics, including coronary visualization. Search of the Quarterly Cumulative Index Medicus covering 1933 to mid-1955 discloses nineteen papers (3–21) dealing primarily with visualization of the coronary arteries during life. Eight additional articles (22–28A) in recent journals bring the total number of reports to twenty-nine.2 Doubt is cast upon the alleged maternal role of clinical necessity by the rough calculation that for each scientific report on coronary visualization in the United States since 1933 there have been a half-million deaths due to arteriosclerotic heart disease! In his Nov. 30, 1945, report, Stig Radner (4) expressed uncertainty as to whether he had succeeded in his efforts to demonstrate for the first time the coronary arteries in living man.
Dotter et al. (Wed,) studied this question.