Andreas Gruentzig
Encyclopedia
Andreas Roland Grüntzig was a German cardiologist
who first developed successful balloon angioplasty
for expanding lumens
of narrowed arteries
.
(the front branch of the left coronary artery) which supplies the front wall and tip of the heart
(see coronary circulation
) which had a high grade stenosis
, about 80%, of the lumen. Dr. Grüntzig presented the results of his first four angioplasty cases at the 1977 American Heart Association
(AHA) meeting, which led to widespread acknowledgement of his pioneering work.
The immediate results of this treatment, despite using only a carefully kitchen built catheter (crude by current standards), was quite good. The patient became and remained angina free after this treatment. This initial patient's result was electively rechecked, by angiography at Emory University
, on the 10-year anniversary of the initial treatment. The LAD narrowing, after this 10-year timespan, remained almost perfectly expanded. There was minimal residual narrowing, probably less than 10%, as seen in similar angle and multiple different views comparing with photographs of the original, 10 years earlier, before and after results.
The excellent results of this initial and subsequent patients were critical to the rapid development and growing acceptance of the angioplasty treatment option. Dr. Grüntzig recognized multiple important issues early: (a) the treatment would not be readily accepted by most physicians, especially bypass surgeons, (b) it could easily lead to bad outcomes without great care in selection of which patients/lesions to treat and of the treating physicians, and (c) it required careful teaching of the technique and its potential difficulties and pitfalls to other physicians, so as to proactively reduce the occurrence of poor results. Understanding these issues and tireless effort on his part are widely recognized in cardiology for being of fundamental importance to the ultimate success of the technique.
By about 1990, lumen stenosis
of the coronary arteries
was more commonly treated by the angioplasty technique than by coronary artery bypass surgery
. This treatment approach is now referred to as plain old balloon angioplasty
(POBA).
In the 1990s, further major improvements, both immediate and especially long term became possible with better understanding of disease as a result of clinical research trials using IVUS and the development of stent
s to mechanically support POBA results.
Since the later 1990s, most angioplasties also involve a stent over the angioplasty balloon; the balloon is hydraulically (typically 6 up to 25 atmospheres of internal pressure) expanded, then deflated and removed while the stent remains behind to mechanically support the lumen remaining in the new, more open shape as created by the hydraulically expanded balloon.
Grüntzig's success remains a major breakthrough and great contribution to the field of medicine in demonstrating that doctors could work inside of the arteries safely, without the need for open surgery. By utilizing the arterial circulation as a "therapeutic highway", many types of devices and drugs can now be delivered directly to the heart, kidneys, carotid arteries, brain, legs and aorta without the need for major surgery and general anesthesia.
in Forsyth, Georgia
on October 27, 1985.
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
who first developed successful balloon angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
for expanding lumens
Lumen (anatomy)
A lumen in biology is the inside space of a tubular structure, such as an artery or intestine...
of narrowed arteries
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
.
Angioplasties
Grüntzig's first successful coronary angioplasty treatment on a human was performed in 1977, in Zurich, Switzerland. He expanded a short, about 3 mm, non-branching section of the Left Anterior Descending (LAD) arteryArtery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
(the front branch of the left coronary artery) which supplies the front wall and tip of the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
(see coronary circulation
Coronary circulation
Coronary circulation is the circulation of blood in the blood vessels of the heart muscle . The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries...
) which had a high grade stenosis
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
, about 80%, of the lumen. Dr. Grüntzig presented the results of his first four angioplasty cases at the 1977 American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
(AHA) meeting, which led to widespread acknowledgement of his pioneering work.
The immediate results of this treatment, despite using only a carefully kitchen built catheter (crude by current standards), was quite good. The patient became and remained angina free after this treatment. This initial patient's result was electively rechecked, by angiography at Emory University
Emory University
Emory University is a private research university in metropolitan Atlanta, located in the Druid Hills section of unincorporated DeKalb County, Georgia, United States. The university was founded as Emory College in 1836 in Oxford, Georgia by a small group of Methodists and was named in honor of...
, on the 10-year anniversary of the initial treatment. The LAD narrowing, after this 10-year timespan, remained almost perfectly expanded. There was minimal residual narrowing, probably less than 10%, as seen in similar angle and multiple different views comparing with photographs of the original, 10 years earlier, before and after results.
The excellent results of this initial and subsequent patients were critical to the rapid development and growing acceptance of the angioplasty treatment option. Dr. Grüntzig recognized multiple important issues early: (a) the treatment would not be readily accepted by most physicians, especially bypass surgeons, (b) it could easily lead to bad outcomes without great care in selection of which patients/lesions to treat and of the treating physicians, and (c) it required careful teaching of the technique and its potential difficulties and pitfalls to other physicians, so as to proactively reduce the occurrence of poor results. Understanding these issues and tireless effort on his part are widely recognized in cardiology for being of fundamental importance to the ultimate success of the technique.
By about 1990, lumen stenosis
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
of the coronary arteries
Coronary circulation
Coronary circulation is the circulation of blood in the blood vessels of the heart muscle . The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries...
was more commonly treated by the angioplasty technique than by coronary artery bypass surgery
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
. This treatment approach is now referred to as plain old balloon angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
(POBA).
In the 1990s, further major improvements, both immediate and especially long term became possible with better understanding of disease as a result of clinical research trials using IVUS and the development of stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
s to mechanically support POBA results.
Since the later 1990s, most angioplasties also involve a stent over the angioplasty balloon; the balloon is hydraulically (typically 6 up to 25 atmospheres of internal pressure) expanded, then deflated and removed while the stent remains behind to mechanically support the lumen remaining in the new, more open shape as created by the hydraulically expanded balloon.
Grüntzig's success remains a major breakthrough and great contribution to the field of medicine in demonstrating that doctors could work inside of the arteries safely, without the need for open surgery. By utilizing the arterial circulation as a "therapeutic highway", many types of devices and drugs can now be delivered directly to the heart, kidneys, carotid arteries, brain, legs and aorta without the need for major surgery and general anesthesia.
Death
Grüntzig, an instrument-rated pilot, and his wife died in an airplane crash in their Beechcraft BaronBeechcraft Baron
|-See also:- Further reading :*Harding, Stephen. U.S. Army Aircraft Since 1947. Shrewsbury, UK:Airlife Publishing, 1990. ISBN 1-85310-102-8.*Michell, Simon. Jane's Civil and Military Aircraft Upgrades 1994-95. Coulsdon, UK:Jane's Information Group, 1994. ISBN 0-7106-1208-7.*Taylor, John W. R....
in Forsyth, Georgia
Forsyth, Georgia
Forsyth is a city in Monroe County, Georgia, United States. The population was 3,776 at the 2000 census. This number was corrected to read 4,300. The city is the county seat of Monroe County.Forsyth is part of the Macon Metropolitan Statistical Area...
on October 27, 1985.
External links
Further reading
- Monagan, David and David O. Williams. Journey into the Heart: A Tale of Pioneering Doctors and Their Race to Transform Cardiovascular Medicine. New York: Gotham Books, February 1, 2007.