is the first part of our interview with cardiology pioneer
Richard K. Myler, M.D., who with Andreas
Gruentzig performed the first coronary angioplasty in the
operating room in San Francisco in May 1977. On March 1, 1978,
Dr. Myler performed the first coronary angioplasty in a cath
lab in the United States. Dr. Myler was a close associate and
friend of Gruentzig, and in this exclusive multi-part interview
he traces the history of this procedure, and offers some perspective
on the current state of interventional cardiology.
Q: When did you first hear of "angioplasty"? Myler: The word angioplasty was developed by Dr.
Charles Dotter in response to a technique that he and one
of his (at that time) young associates, Melvin Judkins, developed
in Portland, Oregon for opening up blocked arteries in the
legs. Dr. Dotter derived it from the Greek words -- "angio",
vessel -- and "plasty", capable of being molded -- and called
their technique "transluminal angioplasty".
In 1968 or '69 at the American Heart
Association meeting in Atlantic City, Dr. Dotter presented
his work. He showed a short movie in which tracks in the
snow suggested there might be some compression of plaque.
In the movie there was a volcanic eruption.
It was very dramatic. Just at the end of the movie he made
a comment, a reference to the fact that though it was used
in the legs, some day it might be used in other systems,
including the coronary arteries.
Sitting in the audience, with perhaps
60 or 80 people, I was stunned, absolutely stunned. The idea
seemed so original and so simple.
We had just landed on the moon, and I
thought, if we can scoop up "moon dust" 387,000 miles from
earth, could we not reach across a one meter catheter and
somehow affect a plaque that was just a few milligrams in
weight, and yet threatened a human life?
With that thought bubbling in my
mind, I called a friend who was also at the meeting -- John
Abele, then the president of a small company in Watertown,
Massachusetts called Medi-Tech. John was also taken with this
possibility. They had worked in their company on some other
devices, not necessarily for the coronaries, but John is an
extraordinarily imaginative man and asked an associate of his,
Itzhak Bentov, to work on a prototype. We had this in hand
within one year.
This was a 3.5F small catheter
with a little cage device on the end which by opening would
push material aside and as it closed it captured the material
within it and then could be withdrawn. This was never used
in a clinical trial.
But John continued to show interest, and
I continued to show interest and he would call me or we would
visit together at one coast or another or at a meeting and
we would chat about this. It was in 1976, he called me from
the apartment of this young man in Zurich who had performed
an angioplasty technique in dogs' coronaries. He said that
this man, whose name was Andreas Gruentzig, was on to something
and it would be good if we met. We chatted for a moment on
the phone and set up an opportunity to meet him at the American
Heart meeting in November.
I recall going up to meet Dr.
Gruentzig who had a poster of this animal work. Most people
who walked by him raised their eyes to the ceiling, implying, "this
is kind of nuts!" -- which, by the way, was precisely the look
I saw in the audience when Charles Dotter presented it some
exhibit at American Heart
John introduced me and my wife Sharon to Andreas. We'd
spoken on the phone and we'd written back and forth so we
were prepared to meet each other. I looked at the poster
and I remember turning to my wife and saying, "For God's
sake, it's a balloon! It's a balloon...". And then after
we talked for a while, I turned to Sharon and said, "We have
to go to Zurich...now!"
Zeitler, Dotter & Gruentzig in Nuremburg, 1977
The next time we met face to face was in March of 1977 and the place
was Nuremberg and the department was Dr. Eberhart Zeitler's 1st International
Angioplasty Symposium. Of course, it reflected the peripheral work
because no one had done coronary work.
I think there were three Americans there
at the time: Dr. Dotter, a very nice fellow named Dave Kumpe,
a radiologist from Denver, and myself. There were no more
than 40 people in this small classroom and on the blackboard
behind Dr. Zeitler was a list of all the places that did
peripheral angioplasty in 1977 -- there were about 10 or
Andreas was very much influenced by
Dotter through his exposure to Dr. Zeitler. I've often said that
Dr. Zeitler was really the "St. Paul" of angioplasty because
he was able to introduce it in a very positive way in Europe.
That was a frustration of Dr. Dotter in the United States since
most physicians who did vascular work were surgeons and at that
time and thereafter were very dubious of this procedure in the
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