History of right heart catheterization: 100 years of experimentation and methodology development

Abstract

The development of right heart catheterization has provided the clinician the ability to diagnose patients with congenital and acquired right heart disease, and to monitor patients in the intensive care unit with significant cardiovascular illnesses. The development of bedside pulmonary artery catheterization has become a standard of care for the critically ill patient since its introduction into the intensive care unit almost 40 years ago. However, adoption of this procedure into the mainstream of clinical practice occurred without prior evaluation or demonstration of its clinical or cost-effectiveness. Moreover, current randomized, controlled trials provide little evidence in support of the clinical utility of pulmonary artery catheterization in the management of critically ill patients. Nevertheless, the right heart catheter is an important diagnostic tool to assist the clinician in the diagnosis of congenital heart disease and acquired right heart disease, and moreover, when catheter placement is proximal to the right auricle (atria), this catheter provides an important and safe route for administration of fluids, medications, and parenteral nutrition. The purpose of this manuscript is to review the development of right heart catheterization that led to the ability to conduct physiologic studies in cardiovascular dynamics in normal individuals and in patients with cardiovascular diseases, and to review current controversies of the extension of the right heart catheter, the pulmonary artery catheter.

Figure 1

Graph demonstrating the differences in oxygen content from matched pairs in samples obtained from the right atria and right ventricle in patients undergoing right heart catheterization. Samples above or below the dotted lines are greater than the alpha level of 0.05 for the mean of the paired groups. From Warren, et al. [16]

Figure 2

Simplified graph demonstrating the differences in oxygen content from matched pairs in samples obtained from the pulmonary artery and right auricle (atria) in patients undergoing right heart catheterization. Samples above or below the dotted lines are greater than the alpha level of 0.05 for the mean of the paired groups. From Dexter, et al. [49]

Figure 3

Simplified graph demonstrating the differences in oxygen content from matched pairs in samples obtained from the pulmonary artery and right ventricle in patients undergoing right heart catheterization. Samples above or below the dotted lines are greater than the alpha level of 0.05 for the mean of the paired groups. From Dexter, et al. [49]