Spring in the Heart

The 44-year-old housewife in the emergency room of St. Joseph's Hospital in Syracuse was in deep shock from massive internal bleeding. The problem: to find its source as fast as possible. Italian-born Dr. Goffredo G. Gensini buttonholed a visitor, Radiologist Charles Dotter from the University of Oregon. Dr. Dotter sterilized the G string of a guitar, punctured the main artery in the woman's thigh. then--watching the steel's progress under the fluoroscope--worked it up into the aorta, the body's main artery. When it was close to the heart, he slipped a thin polyethylene tube over the dangling end, worked this up the artery, using the steel string as a guide, then withdrew the guide. Radiopaque dye injected through the tube showed, on X rays, a ruptured kidney artery. Removal of the damaged kidney and connected artery saved the patient's life.

Simple & Safe. Last week Drs. Dotter and Gensini told the Radiological Society of North America that steel-string and steel-spring techniques can be readily used to guide tubes into the left side of the heart itself--into the left ventricle, which pumps fresh blood to the entire body.* Pioneered in Sweden and France, the method has been adopted by Dr. Dotter in the hope of replacing techniques that, says he, were neither "simple, safe, nor reliable."

As used so far in 70 cases by Dr. Dotter in Portland and in 30 by Dr. Gensini in Syracuse, the procedure begins with insertion of a thick, hollow needle (under local anesthetic) into the femoral artery. Through the needle the diagnostician passes a flexible steel spring, like a plumber's snake (or like the bass strings of pianos and guitars). The needle is soon withdrawn. Inside the steel spring is a single-strand steel wire for stiffening. As in the Syracuse housewife's case, polyethylene tubing is slipped over the steel spring. But in her case, the doctors did not go beyond the aorta. Now they go around the aorta's arch (see diagram) to its end at the aortic valve--the blood's exit from the left ventricle.

Great Advance. By pulling back an inch or two of the stiffening wire, they leave some of the spring pressing against the aortic valve. When the valve's leaves open to let blood out, the tensed spring pushes through, taking the polyethylene tube with it. With the end of this tube in the ventricle, the spring is withdrawn. Diagnosticians can then take samples of blood for a variety of tests, check pressure inside the ventricle, and inject radiopaque dyes for X rays to reveal abnormal or damaged arteries.

Admittedly crusaders for what the profession calls "left ventriculography," Drs. Dotter and Gensini believe that the technique is safe enough to be used in a physician's office. Some cardiologists believe it still advisable to have the patient in a hospital. But they agree that if experience proves the method safe, it will be a great advance over punching a big needle through the chest wall and into the heart itself to get inside the left ventricle.

* The right side of the heart is more accessible through the veins, which deliver used blood to it.

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