Anabasis of PTCA

To the Editor: In a recent editorial in the THI Journal,1 Dr. Ferguson wrote that he had learned two new words: “anabasis” and “apotheosis.” He used the latter to describe the development of the original bulletin called Cardiovascular Diseases: Bulletin of the Texas Heart Institute into an international forum for the discussion of the science and diseases of the cardiovascular system that is today the Texas Heart Institute Journal. He ended the editorial with these words: “Now if I can just find a use for anabasis….” Since he described anabasis as “the advance of an army, especially a large-scale march or expedition moving inland from the coast,” I think that the word expresses exactly the surge of percutaneous transluminal coronary angioplasty. It is little known that Dr. Gruntzig, before performing his first PTCA, along with Drs. Hanna and Myler, tried his balloon in a patient undergoing coronary surgery.2 The balloon was inserted via the coronary arteriotomy and advanced in a retrograde fashion past the lesion. The balloon was inflated at the level of the stenosis. After removal of the catheter, the artery was flushed without evidence of debris. Later, postoperative studies showed improvement of the diameter of the stenosis. This procedure took place in May 1977 in San Francisco, on the coast. An army of cardiologists toting all kinds of weapons3 initiated a large-scale march, moving inland and implementing PTCA as an alternative to surgery in the treatment of ischemic heart disease. Now this is anabasis. And what we surgeons have experienced since 1977 is close to katabasis (a retreat following defeat).