An attempt at the roentgenologic visualization of coronary blood vessels in man.

Visceral angiography was first introduced to medical science through the publication of EGAS MONIZ, in 1927, when he described a method of visualizing the blood vessels of the brain. Since then, the same principles of examination have been applied to an ever-increasing number of the deep blood vessels. The aorta abdominalis and its branches to the abdominal organs were made opaque to roentgen rays by DOS SANTOS, LAMAS & CALDAS in 1929. Two years later, EGAS MONIZ, DE CARVALHO & LIMA introduced arteriographic examination of the pulmonary blood vessels by Forssman’s technique, and in 1936 NUVOLI opacified the aorta thoracalis. Finally, in 1938, CASTELLANOS, PEREIRAS & GARCIA, and ROBB & STEINBERG succeeded in outlining all the chambers of the heart and the great central vessels. The major part of the human circulatory system has thus been made available for intravital exploration. There still exists, however, an important part of the visceral vascular system which lies outside the scope of the angiographic technique, namely, the coronary blood vessels. These vessels have already been the subject of roentgenographic study in the living subject. Thus, in coronary sclerosis, mural calcareous deposits, in some instances combined with regional pathologic changes in the outline of the myocardium, have been described (R. LENK, 1927). While precipitation of calcium can occur in atheromatous coronary arteries with unimpaired function, a secondary circumscribed change in the contour of the heart and the amplitude of contractions, in coronary thrombosis, seems to be of more significance from the diagnostic point of view (LEVENE & REID, 1932). Provided the intervention could be done without undue risk for the patient the visualizing of these vessels would serve as a further aid in the roentgen diagnosis of diseases of the coronary vessels. It is obvious that direct puncturing of coronary arteries is a serious intervention involving risk for the patient’s life, and it should therefore not be done merely in the interests of diagnosis. A more suitable measure seems to be to place the radiopaque substance, after puncturing, in the blood cistern from which these arteries are fed, in other words, in the bulb of the aorta. Working on the basis of this reasoning, P. ROUSTHÖI in 1933 was able to demonstrate that opacification starting from the ascending aorta was possible in different animals. (See fig. 1.) Having confirmed, in the dog, the observations of ROUSTHÖI the next step of the present author was to apply the experiences gained with animals to man. In this connection, a number of technical problems arose, most of which were finally overcome. As far as the technique of injection is concerned, it was already known that NUVOLI had punctured the ascending aorta through the sternum without complications. AS NUVOLI’S paper was only available in the form of a short review the details of his method are not known. His object was to study an aneurysm on the aortic arch by arteriography, and there is thus reason to presume that he endeavoured to visualize this segment of the aorta in particular. The method I employed was briefly the following.