Cardiac angiography and the progress of heart surgery

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The modern era of cardiac angiography began in 1954 with the advent of the fluoroscopic image amplifier. Before that time, from the early 1940s, two groups of physicians were involved in the performance of clinically oriented studies to clarify the nature of cardiac abnormalities. Radiologists were developing angiocardiographic techniques with progressively sophisticated large film changers and cardiologists were involved in the development of catheterization techniques to explore the cavities of the heart and great vessels for the measurement of pressures, flows, and shunts. Both techniques were constrained by severe limitations. In the study of congenital malformations of the heart, physiologic data obtained in the study of complex malformations were often inadequate to define the true anatomic nature of the malformations. In contrast, attempts to introduce relatively large quantities of contrast agent into peripheral veins to photograph its passage through the heart were attended by high risk, particularly in cyanotic patients. Simultaneous opacification of multiple overlapping intracardiac structures severely limited precise identification of intracardiac pathology. However, these limitations were not of overwhelming importance in the era when our surgical efforts were confined to excision of aortic coarctations, ligations and division of patent ducti and closed mitral commissurotomies. They were, however, occasionally responsible for tragic diagnostic errors that led to the misapplication of surgical efforts to produce aortic-pulmonary shunts in patients with cyanotic congenital malformations.

The advent of true intracardiac surgery, facilitated by the development of the pump oxygenator in 1954, spurred the demand for more precise definition of intracardiac structures. The . . .



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