experimental procedure in 1955 to a standard treatment technique in less
than a dozen years.”^17 Any operation into the thorax was unthinkable prior
to World War II, and by 1961, there were 303 hospitals in the United State
fully equipped for open-heart operations and angiography.^18 Cardiac care
had transitioned from the treatment of children with life-threatening
cardiac anomalies to surgical management of cardiac valve disease.
Completely unaddressed was the handling of coronary artery disease and
heart attacks—an even more pressing issue—but it would take a fortuitous
mistake to begin a critical revolution.
On October 30, 1958, Mason Sones, a cardiologist at the Cleveland
Clinic, was performing a cardiac catheterization on a twenty-six-year-old
male with valve disease as part of cardiac workup. At the time, a
catheterization procedure consisted of inserting a thin, flexible catheter
into the brachial artery (of the arm) and threading the catheter all the way
to the root of the aorta, just above the aortic valve. (Today, catheterization
is performed while watching massive, ceiling-mounted flat screen
monitors, but from the 1950s and up into the 1990s, catheterization was
captured on 35mm motion picture film and later viewed on a projector.)
As Dr. Sones was sneaking the catheter tip across the aortic valve, an
automated pressure syringe injected 50cc of contrast solution into the
chamber.^19
Almost all of the contrast material, instead of emptying into the aorta,
filled the right coronary artery, resulting in “extremely heavy
opacification” of the artery and temporary slowing of the heart. “Sones’s
fear that filling a coronary artery with so much contrast would cause a
life-threatening ventricular arrhythmia gave way to a feeling of
‘considerable satisfaction regarding the further diagnostic evolution of the
technique.’”^20 His hopes buoyed by his experience, Sones soon
collaborated with a company to produce custom, taper-tipped catheters to
intentionally catheterize coronary arteries. Overnight, this resulted in the
ability to image the coronary arteries, and more importantly, determine the
degree and location of blockage. Doctors had always been impotent in
determining the cause of chest pain or localizing the relevant area of
vascular blockage—that is, until it was time for an autopsy. The grim
reaper would now have to wait: physicians could now uncover the mystery
of angina and heart attacks in real time, upon a beating heart.