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Dr. Mason Sones, Pioneer in Cardiac Catheterization

Dr. Mason Sones was a legend and force of progress in pioneering the early field of interventional coronary angiography. He was born in a small town in Mississippi (1918), the son of a mechanic. He pursued his undergraduate degree at Western Maryland College and went on to earn his medical degree at University of Maryland (1943). After serving two years in the Army Air Corps, he began his internship in Baltimore and finished his internal medicine residency at Henry Ford Hospital in Detroit. In Detroit, he became interested in congenital heart disease and cardiac catheterization under the mentorship of Dr. Robert Ziegler. Dr. Sones was recruited to the Cleveland Clinic to start a cardiac catheterization lab in 1950 and his first major contribution to the field was successful cardiac catheterization of neonatal patients in 1954.

The early cardiac catheterization labs on the 1950’s performed coronary angiography by injecting large volumes of non-dilute contrast into the aorta which was only capable of opacifying a single coronary artery. Dr. Charles Dotter was also conducting experiments on dogs using a catheter he designed to balloon occlude the aorta and force contrast into the coronary vessels while the heart was temporarily paralyzed by acetylcholine injection. This technique carried significant risks and had not been attempted in humans. The medical community of the 1950’s was incredibly wary of selective coronary artery angiography after prior attempts during left heart catheterization had caused fibrillation and sudden cardiac death.

On October 30, 1958, Dr. Sones and his resident Dr. Royston Lewis were performing a seemingly routine cardiac catheterization on a 26 year old male who had rheumatic mitral and aortic valvular disease. Dr. Sones crouched beneath the exam table, ready to capture the images on the xray and motion picture equipment (images were recorded on 16mm film). The moment before the resident injected the contrast, the catheter tip flipped into the right coronary artery. Before Dr. Sones could stop him, the contrast was injected and images were obtained of the first successful selective coronary angiogram. A large volume of contrast was injected (40-50ml) of non-dilute contrast and the patient immediately went into asystole. Dr. Sones raced to the patient and began ordering for him to cough. Sones knew a strong cough could clear the contrast from the heart. The patient was still conscious and able to follow commands despite sedation medicines and coughed. Thankfully, the patient’s heart began beating again first in bradycardia and then in sinus tachycardia, but he was still alive.

 

Several accounts exist of this monumentous occasion, but it became clear that Dr. Sones recognized the profound impact this “slip” of a catheter could have on the future of angiography. Over the next years, techniques were perfected, contrast volume and concentration changed, and Dr. Sones and his colleagues published his work in 1962 describing his findings in 1,020 patients. The demand for this procedure despite limited therapeutic options continued to grow, with patients waiting months for a coronary angiogram.

 

Dr. Dotter sent a fellow from Oregon Health Sciences University to study with Dr. Sones and learn the “Sones brachial artery cut-down approach”. The fellow was Dr. Melvin Judkins, who eventually became a good friend with Sones, gaining the respect of the brusque and demanding Sones. As the procedures became more widespread, Judkins and Sones became more concerned with utilization of coronary angiography, lack of standards for training, variabilities between laboratories, and the threat of federal regulation. The major cardiology and radiology societies of the day failed to address these concerns; thus, they formed the Society for Cardiac Angiography in 1976. The society has its first meeting in 1976 and has since had name changes and controversies but eventually led to the Society of Interventional Radiology.

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