Angiocardiography (1944)

Angiocardiography had its beginning in 1928, when Robb and Weiss (1) started their studies on cardiac physiology and circulation time in order to ascertain whether visualization of the heart was feasible. Angiocardiography has elucidated many enigmas of the heart and great vessels and has also made it possible to differentiate the vascular from the nonvascular lesions of the mediastinum. In 1931 Forssmann of Germany (2) succeeded in demonstrating the right auricle by introducing into it an iodine preparation, by means of a ureteral catheter, through the veins of the right arm. Subsequent investigators have employed this procedure or some modification of it for demonstration of the cardiac chambers and the great vessels leading to and from the heart. Egas Moniz of Portugal (3) and Ravina (4) and others in France used Forssmann's technic to visualize the pulmonary vessels. In the Western hemisphere, the pioneers in the roentgen demonstration of the abnormalities of the heart and great vessels were Castellanos and Pereiras of Cuba (5–14). Their work, begun in 1931, antedates all work of record in the United States. Their method was devised for infants and children, living and dead, and did not differ fundamentally from that now in use. They threaded a Lindemann cannula into the vein of the arm, preferably the right, and injected 10 to 20 c.c. of a 35 per cent solution of perabrodil. In their later work, however, uroselectan B was used with satisfactory results, not only in the newborn and infants, but also in older children. By their method they visualized only the right heart and pulmonary tree. The left side was demonstrable only if an interauricular or interventricular septal defect was present. In many instances, Castellanos and Pereiras had the opportunity of comparing their roentgen observations with postmortem findings. In the United States Robb and Steinberg in 1938 (15) described a practical method for the visualization of the heart and great vessels. Robb, five years earlier (16), while in Boston, had himself injected with 20 c.c. of uroselectan, hoping to be able to visualize his own heart and vessels by fluoroscopy. As a result of this injection an extensive thrombophlebitis of the vessels of his arm resulted, and the work was temporarily discontinued. The recent literature contains more than a hundred papers on angiocardiography. They range in scope from descriptions of technic to accounts of the demonstration of congenital malformations and differential diagnosis of mediastinal lesions. Notable among the writers are Sussman, Steinberg and Grishman (17, 18, 19), whose work on congenital lesions, intrapulmonary lesions, and technic constitutes a valuable contribution in the field of angiocardiography. Anatomy of the Normal Heart We have found variations from the recognized and accepted radiographic picture of the normal cardiac silhouette. This type of examination affords a means of determining the size and shape of the heart, the presence or absence of cardiac hypertrophy, chamber enlargement, or both; also, the location of the valves and the position of the chambers, the ventricular conus, the pulmonary aorta and its branches, the aorta, and the border-forming structures of the cardiac silhouette.