Witnessing the First PCTA 30 Years Ago

　　在做住院医生期间，Bernhard Meier博士就在苏黎世大学医院的导管室里遇到了Andreas Gruentzig教授。而现在，Meier本人已经是瑞士心血管研究中心（伯尔尼大学）的教授兼主任了，他在回忆那段时光时仍然激动不已。

　　那时，Gruentzig正在进行周围病变的血管成形术，他努力在寻找着适合进行冠脉手术的患者。Meier说：“在恰当的时间他碰到了恰当的病人，所以他赢得了那次手术，没有人能够劝阻他。”

　　Gruentzig教授为此寻找了数月，但没有找到合适的病人。最后，Meier教授把目标锁定在一个38岁的男性患者身上，他的名字是Dolf Bachman。“这是一个最合适的病例，患者年轻，心室功能正常，且病变是单发、非连续的病变。”Gruentzig在看了Bachmann的片子后异常兴奋，他说：“他正是我要找的病人。”

　　Gruentzig对Bachmann解释说这将是首个在人体进行的手术，在与患者沟通了10分钟后，患者同意了手术。Meier回忆说，患者听得十分仔细，因为他还很年轻，他希望能够用尽量小的创伤换来更长的生命。

　　在手术开始时，Gruentzig有点紧张，但很快就恢复了平时的状态。随着Gruentzig教授将球囊移向病变，设备首先进入了侧支，但第二次尝试时，球囊很准确的划向了病变。

　　Meier回忆道：“当他最终决定充起球囊时，我知道最关键的时刻到了，每个人都在看着病人。病人会怎样？他是否会晕过去？他是否会疼得叫出来？他是否会出现心律失常？这是我们每个人心里的问号。”

　　随着球囊的释放，患者恢复了平静。Gruentzig教授推入了造影剂，Meier说：“我不知道他的手是否在颤抖，但我想他一定也很激动。”

　　图像显示血管状态明显改善，很多人叫了出来，噢，那太棒了。造影室里有些人指出还有一个病变在对角支那里，Gruentzig抽回了球囊，并将其推入了侧支，并第二次充起了球囊。结果同样很完美，这个狭窄也消失了。

　　随后，Meier和Gruentzig意识到第一次充气造成了右丛支的阻塞，他们认为这是血管成形术常常会遇到的问题，但对结果不会有太多影响。这个事件也是很有意义的，第一个病人就出现了副作用，使得随后千千万万的术者都免于这种不良反应。

　　Meier说：“现在来看，就算无法在球场上的大屏幕上对千百万人转播，也应该通过闭路电视给予录制，因为它实在太重要了。”

　　（北京协和医院　鲁勖　编译）

　　（医心网独家授权资料，转载请注明出自医心网）

Witnessing the First PCTA 30 Years Ago

Bernhard Meier, MD, remembers the tension and 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 oral consent 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 going out of rhythm? Was he going to fibrillate?”

As the balloon deflated, the patient remained quiet. Gruentzig then injected contrast. “I don’t know whether his 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.”