The daring experiment of probing a heart

Modern Cardiology is inconceivable without the presence of interventionism. Thus, Interventional Cardiology is recognized as a subspecialty through which medical procedures known as minimally invasive are carried out.

This means that extensive wounds are not required to diagnose problems related to blood circulation and heart function, and even to perform cardiac treatments. Only small incisions are enough through which are introduced elongated and very thin tubes, known as catheters, which allow them to reach the heart.

Medications can be administered through these devices; and also unclog blood vessels, insert pacemakers, and repair heart valves and congenital heart defects.

To reach these achievements of the medical sciences, a long way had to be traveled in which much had to do with the intrepidity of a German doctor named Werner Forssmann.

Story of an inspiration

Werner Theodor Otto Forssmann was born in 1904 in Berlin, Germany. Orphan of a father and from a middle-class family, he showed his desire to be a doctor from an early age.

He finished his medical studies in 1928, in the capital of Germany. His graduation thesis dealt with the effect of diet on red blood cells and blood cholesterol level in healthy humans.

At that time, although he was already going to self-experimentation to unravel secrets of the body and the physiology of human beings, the young student could not imagine that a year after the discussion of his thesis, the topic chosen by him would have nothing to do with it. with other studies that would motivate him, make him suffer disagreements and eventually lead him to fame.

Before starting work in 1928 as an assistant physician in the department of Surgery of a hospital in Eberswalde (a town near Berlin), Werner Theodor Otto Forssmann worked for a short time in a private gynecological clinic.

But it was at Eberswalde that he identified the optimal conditions for being able to “let good ideas mature” and carry out far-reaching research.

Far from being a vision, Dr. Forssmann’s inspiration to undertake what is now called cardiac catheterization came from the sketch in a physiology textbook that referenced observations made in 1844 by the physiologist Claude Bernard in order to measure the pressures and temperature in the heart chambers. Such measurements were achieved with the insertion of a long, thin glass tube into the jugular vein and carotid artery of a horse: thus the heart of the animal was reached.

This seemed workable in humans, as a way to diagnose and administer medications. But unlike horses, he proposed to perform the procedure through the veins in the crease of the arm, as they are more accessible.

For most of the people who surrounded the young doctor, these ideas could be considered as true alienation and without a logical profit.

In the spring of 1929, Forssmann finally carried out a self-experiment. He himself inserted a sufficiently long urethral catheter (used to probe the urinary bladder) into one of his right arm veins – the ulnar vein – the end of which, after a second attempt and without feeling pain, was successfully directed to the right atrium of the patient. heart.

For this he had the help of a nurse who was partly oblivious to self-experimentation. The procedure could be documented by X-rays taken in a hospital room where the doctor worked.

After getting the proof he needed to prove his experiment, Forssmann removed the tube without incident.

The impact

After the self-experiment, the reactions of most of the German doctor’s colleagues were hostile towards him. He faced reprimands from his mentor, Dr. Schneider, and from the medical community. Many were apparently disgusted with his methods, foundations and approaches, believing them too dangerous.

After repeated self-experiments, Dr. Forssmann concluded that his “self-catheterization” procedure could be performed safely. His works were presented to the German medical community.

Only a few scientists took notes on the study and even integrated parts of their technique into their own research studies. The young Forssmann went on and carried out further experiments on rabbits and dogs; and developed inguinal cardiac catheterization as a way to reach the inferior vena cava through the femoral veins.

In one of his lectures at a medical conference, Forssmann noted how bored the audience was. He also noticed murmurs, expressions of displeasure and even ironic laughter within that audience.

Her uncle, a physician who at that early stage seemed to understand the real importance of cardiac catheterization, told her not to be upset by the public’s lack of understanding. And he added in the form of consolation: “You will see that one day you will win the Nobel Prize for your discovery.”

After seeing that the majority of the scientific community of that time aggravated or ignored his work, and appreciating that he could not advance beyond what was achieved at that time, the doctor considered that he had reached the limit of his exploratory experiments. His life and career goals were totally shuffled when he decided to work as a urologist in a rural German community, away from the environment of cities and crowds.

More than two decades had passed when, in 1956, Forssmann surprisingly received the Nobel Prize in Medicine. The award was shared with American doctors André Cournand and Dickinson W. Richards – affiliated with Columbia University, New York – who, with the help of X-rays, fueled the development of procedures that use catheters placed throughout of the arteries or veins of the human body to diagnose and treat conditions without the need for open surgery.

It can be argued that when Forssmann took the risk of probing his heart, he began to ditch the paths of central and peripheral catheterization —as we know them today—, consisting of a technique that has become a peremptory instrument for the diagnosis and treatment of many diseases.

Consulted bibliography

Afshar A, Steensma DP, Kyle RA. Werner Forssmann: A Pioneer of Interventional Cardiology and Auto-Experimentation. Mayo Clinic Proceedings. 2018; 93 (9): e97-e98. doi: 10.1016 / j.mayocp.2017.08.026

Packy LM, Gross D. Between Cardiology and Urology: Werner Forssmann’s Double Career. Urologia Internationalis. 2019; 103 (1): 1-7. doi: 10.1159 / 000499093