Abstract
The idea of right heart catheterization (RHC) grew in the milieu of modern thinking about the cardiovascular system, influenced by the experiments of William Harvey, which were inspired by the treatises of Greek philosophers like Aristotle and Gallen, who made significant contributions to the subject. RHC was first discovered in the eighteenth century by William Hale and was subsequently systematically improved by outstanding experiments in the field of physiology, led by Cournand and Dickinson Richards, which finally resulted in the implementation of pulmonary artery catheters (PAC) into clinical practice by Jeremy Swan and William Ganz in the early 1970s. Despite its premature euphoric reception, some further analysis seemed not to share the early enthusiasm as far as the safety and effectiveness issues were concerned. Nonetheless, RHC kept its significant role in the diagnosis, prognostic evaluation, and decision-making of pulmonary hypertension and heart failure patients. Its role in the treatment of end-stage heart failure seems not to be fully understood, although it is promising. PAC-guided optimization of the treatment of patients with ventricular assist devices and its beneficial introduction into clinical practice remains a challenge for the near future.
Highlights
Right heart catheterization (RHC) has emerged as an invasive procedure with a potent role among the current armory of clinical diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI), and genetical immunoassays sampling [1,2]. The birth of this technique is strictly associated with the genial English physiologist and physician William Harvey (1578–1657), who proposed a theoretical model of the functioning of an animal circulatory system, which he unveiled in the work entitled Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus and published in 1628 in Frankfurt [3]
Patients with right heart catheterization (RHC) had an increased 30-day mortality; The mean cost (25th, 50th, 75th percentiles) per hospital stay was $49 300 ($17,000, $30,500, $56,600) with RHC and $35,700 ($11,300, $20,600, $39,200) without RHC; Mean length of stay in the ICU was 14.8 (5, 9, 17) days with RHC and 13.0 (4, 7, 14) days without RHC; Conclusions: After adjustment for treatment selection bias, RHC was associated with increased mortality and increased utilization of resources
Complications were uncommon and were reported at similar rates in each group: 0.08 ± 0.01 per catheter inserted in the pulmonary artery catheters (PAC) group and 0.06 ± 0.01 per catheter inserted in the CVC group (p = 0.35); 8
Summary
To elucidate the state of the art of right heart catheterization, focusing on the background of the initial experiments and its physiological meaning, which leads to its implementation in clinical practice.
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