[TCT2007]Witnessing the First PCTA 30 Years Ago

Bernhard Meier, MD, remembers the tensionand Andreas Gruentzig’s calm.

Early in his residency, Bernhard Meier, MD, met Andreas Gruentzig, MD, in the angiology and radiology department at Zurich University Hospital. Meier, now professor and head of cardiology at the Swiss

Cardiovascular Center at Bern University Hospital, recalled being drawn to Gruentzig, a charismatic East German.

At that time, Gruentzig was performing angioplasties in peripheral lesions. He was looking for the right
candidate for a coronary procedure. “He just knew that in the right situation with the right patient, he would pull it off. Nobody could convince him to the contrary,” Meier said recently.

For months, Gruentzig waited, but none of the patients seemed appropriate. Finally, Meier located a candidate,
a 38-year-old local man named Dolf Bachmann. “Here was exactly what Andreas had been looking for
all that time — a single, discrete lesion in a very young male with normal left heart function,” said Meier.

Gruentzig looked at Bachmann’s films and got excited. “He said, ‘This is exactly my patient.’”

Gruentzigsaw Bachmann and explained that this would be the first such procedure in a human. Gruentzig received oralconsent in about 10 minutes, Meier recalled.

“The patient listened quite intently because he was a young man who wanted to survive with as little intervention as necessary,” said Meier.

At the beginning of the procedure, Gruentzig was “maybe a little more talkative than normal,” said Meier, but otherwise betrayed no nervousness.

As Gruentzig moved the balloon to the lesion, the device first pushed into a side branch. But during the second attempt, the balloon slid through to the lesion.

“When he was finally ready to step on the pedal to inflate the balloon, I think that was the first really
tense moment,” recalled Meier. “Everybody, particularly Andreas, was looking at the patient. What was the
patient going to do? Was he going to faint? Was he going to shout out in pain, and was his heart rate goingout of rhythm? Was he going to fibrillate?”

As the balloon deflated, the patient remained quiet. Gruentzig then injected contrast. “I don’t know whetherhis hand trembled, but I’m sure it must have,” said Meier.

The first images showed clear improvement. “Some people started shouting, ‘Oh, it looks great,’” said
Meier. “It got out of hand for 5 or 10 minutes.”

Someone in the room suggested that there was a second lesion in a diagonal branch. Gruentzig pulled the
balloon back and pushed it into that branch and inflated it a second time.“Of course it turned out that there was no lesion in that other side branch,”said Meier.

Later, Meier and Gruentzig realized the first inflation had created a right bundle branch block. They
thought this would be a common event in angioplasty, but it turns out to be exceedingly rare. “This was
kind of funny — that the first patient had some side effect that would not be reproduced in thousands of others later,” said Meier.

“Looking back now, this should have been at least on live closed-circuit television, if not put in a football stadium with 100,000 people watching because it was so important,” said Meier. “But this was clearly not perceived at the time.”