Creativity, ingenuity, serendipity

Some of the earliest experiences of invasive cardiology centred on studying the physiology of congenital heart disease in a series of ongoing attempts to understand pathophysiology and anatomy, and then devising strategies to treat the lesion. Tremendous growth in the field and rapid advances in patient care have become possible due to the collaboration of early investigators, including pediatric cardiologists, cardiovascular pathologists, ernbryologists, physiologists and cardiovascular surgeons. This group has expanded to include radiologists, vascular biologists and engineers. Mason Sones' serendipitous encounter with a patient led to the thought that one patient's 'complication' might lead to another therapy and, as a result, studies were conducted. Early equipment was bulky, rigid and inflexible. Andreas Gruentzig was instrumental in the development of several new techniques. Throughout the development of invasive cardiology, great attention has been paid to the evaluation of both successful and failed outcomes. Over the intervening years, multiple advances in technology have improved procedures by making invasive cardiology easier, safer and more predictable and have expanded the patient population that could benefit from it. These advances included new devices, such as atherectomy transluminal extraction catheters, as well as with directional coronary atherectomy, rotational atherectomy and laser-based techniques. Interventional cardiology has soared with single-centre and multicentre randomized trials. Intracoronary stents have completely revolutionized therapy, becoming smaller, more flexible and more easily deliverable. With the introduction of drug-eluting stents, restenosis rates have been dramatically reduced. However, chronic total occlusion continues to be a problem in interventional cardiology due to increased risk of early and late complications and increased restenosis rates. New areas continue to be developed, combining the inventions and designs of collaborators. An increased knowledge of the basic pathophysiology of cardiovascular disease, combined with creative technology and imaginative operators, will continue to advance the field.