Andreas Gruentzig — the Life and Death of a Pioneer

Andreas Gruentzig — the life and death of a pioneer

The history of cardiology is rich The innovation of placing a latex with pioneers whose contributions pa- balloon in an angiographic catheter be- ved the way to the advancement of in- longs to Dr. Portman, and this trigge- vasive cardiology, but not all of them red Dr. Gruentzig to use this method have been recognized and appreciated to dilate a constricted coronary artery. for their innovations and accomplish- It took Andreas two years to solve “mi- ments. The late Andreas Gruentzig nor” technical problems from conce- was a pioneer, who was acclaimed even iving his idea till its true application. It in his lifetime, as were Forssmann, is now legendary that Gruentzig wor- Cournand and Richards, who were even ked, together with his wife Michaela, crowned by the Nobel Prize Commit- his assistant Maria Schlumpf and her tee. There were many other pioneers husband Walter, in the family kitchen whose contributions are less recognized in history, in the evenings trying many versions of the balloon like Otto Klein of Prague, while other outstanding cli- catheter. The preparations included, among other nicians whose contributions were widely known even things, cooperation with factories, chemists and during their life time, but in retrospect it seems that many other technical experts. After hundreds of unfortunately did not receive enough official recogni- experiments, Gruentzig was satisfied with the tech- tion as in the case of Charles T. Dotter and Mason nical details of the catheter and having also solved Sones. The ground breaking contribution of Andreas the problem of the “double lumen catheter”, he felt Gruentzig: his life; his work; and his tragic death, are that the time was ripe for its use in humans as well. the subject of this article. January 23, 1975 was the date of the first suc- Andreas Roland Gruentzig was born in Dres- cessful use of a double lumen catheter in a patient’s den, Germany in 1939 and following WWII he was iliac artery. Then back in the “kitchen”, it took ano- taken as a child by an uncle to Argentina, later re- ther 6 months till Gruentzig was satisfied that his turning to Leipzig, Germany. In 1957 he crossed catheter was small and safe enough to be induced through Berlin to Heidelberg in the West and in into the coronary arteries of dogs. In November, 1964 he graduated medical school. Becoming a fel- 1976 at the Scientific Sessions of the American low of the University Hospital in Zurich in 1969 Heart Association, Dr. Gruentzig presented his Andreas took up angiology, which at that time was animal experiments in a poster session [3]. Here a sub-speciality of internal medicine. From the started the friendship and the scientific collabora- Angiology Department, headed by Dr. Bollinger, he tion between Andreas and Dr. Richard Myler of San continued to Radiology, headed by Dr. Wellauer. Francisco which resulted in several intra-operati- Working in this department, Andreas happened to ve balloon dilatations of coronary arteries during visit Dr. Eberhard Zeitler [1] and observed a pro- May, 1977 at St. Mary’s Hospital, San Francisco. cedure of peripheral artery “angioplasty” using the Gruentzig’s aim of course was to dilate an ob- “Dotter Method” [2]. Even though this particular structed coronary artery on the catheterization ta- procedure was unsuccessful, he felt confident eno- ble in a patient while he/she is awake. The search ugh to start performing intravascular angioplasties for a suitable patient, who was defined as one with on selected patients. In 1974 Gruentzig’s commen- a single vessel disease and good left ventricular ced his formal training in cardiology in the Depart- function went on for several months, both in San ment of Cardiology headed by Hans Peter Krayen- Francisco and Zurich. Finally, and surprisingly, the buhl and Wilhelm Rutishauser. patient who voluntarily agreed to this trial method

348 www.fc.viamedica.pl Shlomo Stern, Andreas Gruentzig — the life and death of a pioneer was found in Zurich. Gruentzig back in Switzerland, zing there courses to teach his methods, but he was met the patient, a 38 year old insurance salesman, frustrated by the limitations his superiors placed on who suffered from severe angina, had a positive him in further developing “coronary angioplasty”, exercise test and in whom a severe proximal left and by the relatively slow spread of PTCA’s in Eu- anterior descending stenosis with good left ventri- rope. It is therefore easy to understand that he co- cular function was found. A relatively short conver- uldn’t resist an invitation from Atlanta’s Emory sation between the patient and Dr. Gruentzig se- Hospital to resettle there, as Director of Interven- emed to satisfy the ethical aspect of his consent, tional Cardiology and full professor. Dr. King de- let us remember this was the year of 1977. scribed [7] Andreas’s hesitations before he decided Dr. Bernhard Meier, himself a resident physician at to make this leap, yet he became convinced that wor- that time, witnessed the act of obtaining the “infor- king in America will promote his method and will med consent” from the patient for the first ever co- influence centers all over the world to adopt PTCA, ronary dilatation procedure. Later, Dr. Meier called which, he knew was his life’s true achievement. the patient’s eager consent to Dr. Gruentzig’s pro- Andreas Gruentzig’s career in the US was posal “a lucky thing for the future of angioplasty” [4]. extremely successful. Emory became a leading cen- Dr. Gruentzig performed on this patient the ter of PTCA’s in America, and at the same time first PTCA in a cath lab in Zurich Switzerland on several important advancement’s using the ballo- September 16, 1997. As this patient became angi- on procedure, were made in other centers in the na free immediately after the procedure and rema- U.S. and Europe as well. Shortly angioplasty has ined so for several weeks (and as a matter of fact, been used in patients with acute myocardial infarc- even 10 years later, when he was recatheterized at tion as pioneered by Meier et al. [8], and multi-ves- Emory Hospital in Atlanta, the artery dilated sel disease also became soon amenable with angio- 10 years earlier, was found to be open, without re- plasty, as shown by Hartzler et al. [9], all these pa- stenosis) Dr. Gruentzig felt it proper to publish this rallel with technical improvements in the catheters case, with the other 4 “first” ones in Lancet [5]. and balloons used. At Emory, between 1980–1985 His first cases were also presented in Miami Be- the team, headed by Drs. Gruentzig, King and Do- ach at the American Heart Association’s Scientific uglas, performed over 5,000 PTCA’s and spread the Sessions [6]. The writer of this article, who was at knowledge by organizing 10 angioplasty courses for this meeting presenting his own paper, remembers American and overseas cardiologists. how Dr. Gruentzig’s lecture was immediately ac- A terrible tragedy and loss is the only way to cepted by the enthusiasticly applauding audience as describe the fate of Andreas Gruentzig. On Octo- a breakthrough communication. ber 27, 1985, at a time which could be seen as Looking back 40 years later, it is amazing to a zenith in his career, he was piloting his twin-en- see the immediate huge interest in this procedure gine plane between his two homes in Atlanta and in the U.S. and the lack of enthusiasm on this side Sea Island when over Monroe County, in an une- of the Atlantic Ocean. A certain “conservatism” xpected storm, the plane crashed. Andreas and his which prevailed in European Medicine after WWII, second wife Margareth Ann, were instantly killed. a reluctance to accept the performance of a thoro- Andreas is survived by his only daughter. ughly invasive technique by a non-surgeon and Even so, Andreas Gruentzig could see that maybe a lack of self-confidence by European car- even during his cut-short life, his dream came true. diologists to perform a procedure which requires He must have been aware of the great appreciation cardiac surgeons to stand-by, could all have played and admiration of his colleagues the cardiologists, a part in the slow progress in performing PTCA’s of the whole medical establishment, and last but not in Europe. In the U.S., early co-workers and friends least, of grateful patients who owed their improved of Andreas Gruentzig such as Richard Myler, Simon quality of life and frequently even their life, to his Stertzer were excited about the success of the ca- unique pioneering achievements. After his death, ses performed in Zurich and in March, 1978 they Emory’s Cardiovascular Center and several other in- performed nearly simultaneously in San Francisco terventional laboratories in the world carry Gruent- and New York the first American cath lab PTCA’s. zig’s name, the International Andreas Gruentzig So- In the U.S. balloon dilatations for coronary ar- ciety, launched in 1990, carries the torch for cardiac tery disease spread like bush fire. Between 1978– and vascular interventions, Fellowships on his name 1980 PTCA’s were performed in tens of Hospitals and many endeavors serve the noble aim of preserving on hundreds of patients — and mostly successfully. Andreas Gruentzig’s memory and heritage. Meanwhile Gruentzig made all the efforts to keep Be this article a small token for his enormous Zurich as the world center of PTCA’s, by organi- achievements.

www.fc.viamedica.pl 349 Folia Cardiol. 2006, Vol. 13, No. 4

References 5. Gruentzig A. Transluminal dilation of coronary artery stenosis. Lancet 1978; 1: 263. 1. Zeitler E, Schoop W, Zahnow W. The treatment of 6. Gruentzig A, Myler R, Hanna R, Turina M. Coronary trans- occlusive arterial disease by transluminal catheter luminal angioplasty. Circulation, 1977; 56: 84 (abstract). angioplasty. Radiology, 1971; 99: 19–26. 7. King S.B. III. Angioplasty from bench to bedside to 2. Dotter CT, Rosch J, Judkins MP. Transuminal dila- bench. Circulation, 1996; 93: 1621–1629. tion of atherosclerotic stenosis. Surg Gynecol Ob- 8. Meier J, Merx W, Schmitz H et al. Percutaneous stet, 1968; 127: 794–804. transluminal coronary angioplasty immediately after 3. Gruentzig A, Turina, M Schneider J. Experimental intracoronary streptolysis of transmural myocardial percutaneous dilatation of coronary artery stenosis. infarction. Circulation, 1982; 66: 905–913. Circulation, 1976; 54: 81 (abstract). 9. Hartzler GO, Rutherford BD, McConahay DR, 4. Meier B, Gruentzig, the father of balloon angioplasty McCallister SH. Simultaneous multiple lesion coro- — I was there! Interview with Dr. George A. Beller. nary angioplasty: a preferred therapy for patients ESC Congress, Rapid News Summaries, Cardio- with multiple vessel disease. Circulation, 1982; 66: source, 2003. 905–913.

Shlomo Stern, MD Emeritus Professor of Medicine 1 Shmuel Hanagid St Room 201, Medical Building Jerusalem, 94592, Israel e-mail: [email protected]

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