An Accident Paves The Way For Modern Heart Care

Cardiac catheterization began with a jolt, but launched a revolution

As he rushed to aid his stricken patient 55 years ago this October, Cleveland Clinic cardiologist F. Mason Sones, MD, worried that the dye he had inadvertently injected directly into the young man’s heart would kill him.

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Instead, what seemed like a grave medical error on the day before Halloween, 1958, proved to be a monumental breakthrough. It would help launch the modern era of heart disease diagnosis, and would transform Cleveland Clinic into a world leader in coronary care.

Looking inside the heart

Dr. Sones was a pioneer in coronary angiography, the imaging technique that uses X-ray equipment and special catheter-delivered high-contrast dyes to allow doctors to see inside the heart and its blood vessels.

By 1958, angiography was able to produce clear views of the heart’s valves and pumping chambers, as well as the interior of the aorta, the big artery that routes blood to the body. But the small, wispy coronary arteries that keep the heart muscle itself supplied with blood – and whose blockage causes heart attacks – seemed off limits. Conventional wisdom among cardiologists was that shooting dye into the coronary arteries would stop the heart and kill the patient.

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Risky technique

CCF Archive FileDr. Sones was intent on finding a way to see inside the coronary arteries and look for obstructions. He experimented with edging the catheter closer and closer to the opening where the arteries branched away from the aorta, and injecting a large cloud of dye that he hoped would diffuse in small, safe amounts into the coronary arteries. Dr. Sones was testing this technique on Oct. 30, 1958, when disaster seemingly struck.

As Dr. Sones turned on his X-ray camera and told his colleague to inject the dye, he saw a startlingly clear image of his patient’s right coronary artery, filling with a dark, ominous billow. He realized the catheter tip must have slipped into the small vessel, delivering most of its potentially lethal contents directly to the heart muscle. “Pull it out!” the horrified cardiologist shouted, and jumped from his position in an equipment pit beneath the surgical table to try to help his patient. A monitor showed the man’s heartbeat had flat-lined.

“I climbed out of the hole and ran around the table looking for a scalpel in order to open his chest” and massage his heart, Dr. Sones recounted in the 1993 book “The Catheter Introducers.” But instead of cutting, Dr. Sones yelled at his still-conscious patient to cough. He knew that an explosive cough causes a sudden pressure pulse in the aorta, which he hoped would expel the dye from the coronary artery. The gamble worked. After the patient hacked three or four times, his heart resumed beating and he eventually recovered.

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Medical breakthrough

Though frightening, the incident was a revelation for Dr. Sones, whose subsequent research defined the appropriate amounts and types of contrast dyes to produce clear images of blocked coronary arteries. “All of a sudden, he realized that you could selectively catheterize each of the coronary arteries and create a road map for medicine and surgery,” Floyd D. Loop, MD, former Cleveland Clinic CEO, said in the documentary “All For One: The Story of Cleveland Clinic.”

It would take another Cleveland Clinic breakthrough – the first documented successful coronary artery bypass surgery using a saphenous vein in 1967 by Rene Favaloro, MD – for physicians to successfully begin to treat the blockages Dr. Sones first observed. But his fortunate accident on Halloween Eve led to international prominence for Cleveland Clinic and helped pave the way for the cardiac care we know today.

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