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March 29, 2017
Cardiac Catheterization Werner Forssmann

Werner Forssmann (1904-1979)

Die Sondierung des rechten Herzens. Klin. Wschr., 1929,8, 2085-87,2287

Werner Forssmann
Portrait of Werner Forssmann
Portrait of Werner Forssmann


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Werner Theodor Otto Forssmann was a German physician and was the first to develop a technique for the catheterization of the heart in human.  He was a surgical resident when he became interested in the procedure.  In 1929, Forssmann passed a ureteral catheter in the antecubital vein of his right arm for a distance of 35 cm. He then walked to the department of radiology and placed himself behind an X-ray screen and watched in a mirror the position of the catheter.  It was in the area of the shoulder joint. He then advanced the catheter up to 65 cm and verified the position of the tip which was lying in the right atrium.  The final position of the catheter was documented with a chest X-ray.

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Forssmann published the result of his experiment in November of 1929. It initially raised some criticism which was followed by a long period of indifference. A few weeks after his publication, Forssmann became aware that Fritz Bleichroeder and two colleagues had carried out similar experiences both in animals and man in 1912. In their experiences, ureteral catheters were inserted into the peripheral veins and then advanced toward the central venous system. Taking into consideration their length, these catheters might have been positioned in the right atrium, but their position was not documented as X-rays were not performed routinely at that time.

In both Forssmann and Bleichroeder approaches, the primary goal of central catheter insertion was the intracardiac delivery of medications.

At a later date, Forssmann reported the injection of organic iodine through the catheter in an attempt to obtain X-ray visualization of the pulmonary arteries. Due to multiple technical difficulties and mediocre quality of contrast agents, the resultant films were of limited value and he abandoned this pathway.

Forssmann's pioneering work created a great interest in the clinical application of this new imaging modality.  More than a decade later, Cournand and Richards started their investigational studies of the right heart cardiac catheterization. Forssmann, Cournand and Richards were awarded the Nobel Prize of medicine in 1956.


REFERENCES

Bleichroeder F. Intra arterielle therapie. Bel  Klin Wschr 1912;49:1503

Forssmann W. Uber Kontrastdarstellung der Hohlen  des lebenden rechten Herzens  und der Lungenschlagader.  Munchen Med Wchnschr 1931;78:482-92


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Jean Baptiste Auguste Chauveau Andre Frederic Cournand


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