Entertaining and informative, this witty look back at the early genius and ridiculously rudimentary pci techniques made me feel as if the first ptca's were done in an era when we were still rubbing two sticks together to start a fire. I fully expected to leave this presentation only to see Rachael Welch running from a dinosaur in her bear skin two- piece.
I gained a whole new respect for intervention today but still marveled at How on earth we ever got here from the dark but genius age of Gruentzig and colleagues? Let me just navigate you through the typical day in the cath lab" way back when"as described by Geoffrey Hartzler as told with Jackie Gleason style humor.
A typical PTA case: (That's Peripheral transluminal angioplasty, for you babes born long after the first procedure was performed)
The year is 1980 BC, ....I mean AD. You were handed an .063 guide wire. ( No, you weren't going to fence with it you were going to navigate a trek from the femoral artery to the aorta with it.) Too bad we didn't recycle back then, After the cath, one could have used it to do a nice artsy wire sculpture. Once the coronaries were visualized, you requested the "steam kettle". No joke, a "steam kettle" to help warm the guide and sculpt it into the shape needed. After it was determined that the patient was to have a PTA, you took a stiff tipped balloon with a distal spring wire , (kind of reminded me of the size and shape of a tonsil tipped suction apparatus) and reamed the heck out of the vessel. There was only one balloon, the advantage of which was that you didn't have to waste all that time sizing, etc.) When you did your 5-6 atm. inflations, "the balloon always , ALWAYS broke". There was NO HEMOSTATIC valve which meant you had soggy sox and shoes, dripping with the patient's blood through out the entire procedure. 2 unit transfusions were not uncommon at the close of a routine procedure.
No time was wasted on a Pharmacology decision making process as the patient received isordil po, dextran, heparin and at the end of every case, they were reversed with protamine. ASA and Dipyridamole were all they had back then in the way of oral angicoagulants, but they were FORBIDDEN because the surgeon refused to operate on the patient if they had taken an aspirin.
Then, at the end of the day, everyone was so relieved and grateful to have an open vessel. But really, what did they have to worry about? After all, their procedural success rate was 72%!!!
Dr. Hartzler then described his first successful PTA case for STEMI . He asked for his case to be placed on the table to which the nurse replied that the cath had been canceled because he had developed chest pain with ST elevation and bradycardia.(That's about as ridiculous as saying I'm not going to dinner because I'm hungry). He evaluated the ECG and sure enough, inferior injury pattern was full blown. (This was July 1980). Unfortuanately, the film was lost forever but he did show one that looked as if Charlie Chaplin would walk by, twirling his cane, at about 1 frame per second it seemed, that demonstrated the opening of an artery with a GIGANTIC banana shaped balloon. The patient however became completely pain free and ST's were normal. The LV gram normalized completely at a recath some weeks to months later. By Joe, Dr. Hartzler, I do believe you were on to something!!
Thus PCI for STEMI was born. And to think, we quibble today over such ridiculous things as surgical back up. The way I look at it, if we aren't using a steam kettle to shape the guiding catheter, I think the patient is probably pretty safe.
Needless to say, I'll never view the interventional world in the same light again. In the now famous words of the infamous GARTH and Wayne of Wayne's world, every time I see Dr. Hartzler from now on.......I'm going to bow and say "We're not worthy, WE'RE NOT WORTHY!!"
Because you know what.??.....we're not. Nothing can compare with the story of the birth of PCI and the courageous and genius antics of the first cardiologists who invented PTA. NOTHING.
Cite this: Geoffrey Hartzler-my hand is over my heart in hommage to your work. Thank you! Thank you!!! Thank You!!!!! - Medscape - Oct 15, 2008.