The aim of this work was to identify among several Polish candidates (Rutkowski, Ławkowicz, Juszczyński, Kossakowski, Poradowska, Moll, Kustrzycki) the one who performed the first cardiac catheterization.

The first cardiac catheterization in Poland was performed by the Swedish physician Erik Hanson on July 22, 1948 in Warsaw, at Wolski Hospital under Leon Manteuffel [1]. The patient was a 12-year-old boy with tetralogy of Fallot. Hanson belonged to the team of the Swedish cardiac surgeon Clarence Crafoord, who came to Poland at Manteuffel’s invitation. The next day, July 23, 1948, Crafoord performed the Blalock-Taussig anastomosis on the boy.

The question of the first cardiac catheterization in Poland performed by a Polish physician is a disputed matter. An analysis of the medical records of patients who underwent catheterization could not be conducted due to the passage of time since the first catheterizations and the destruction of archival materials. Therefore, the discussion is based on literature sources, whose authors are the candidates, mainly Rutkowski and Ławkowicz. The discussion concerns the right heart.

Prof. Jerzy Rutkowski directed the Second Department of Surgery at the University of Łódź (later the Medical University of Łódź) at S. Sterling Hospital in 1947–1955.

In a letter to Kardiologia Polska [2], the date of the first cardiac catheterization performed by Rutkowski [3, 4] was stated as between November 19 and 30, 1948.

Filipiak, Tyszkiewicz and Rużyłło [5] responded critically to the letter, stating that Ławkowicz’s priority had not been questioned until now.

The first catheterization was documented in detail, including radiographically (X-ray), in Rutkowski’s monograph titled Surgery [1]. The following passage from this book refers to the procedure: “The first cardiac catheterization in Poland, as far as we know, was performed in the Second Department of Surgery of the Medical University of Łódź (1948 – see fig. 710)” [1].

The fact that this was the first catheterization in Poland performed by a Polish physician was confirmed in other sources [4].

An exact date for catheterization by Ławkowicz is missing. Literature sources provide only the year 1948 [5], making it impossible to determine who performed the first catheterization.

Prof. Izabela Krzemińska-Ławkowicz (doctorate in 1948) worked in 1946-1948 in the Second Department of Internal Medicine of the Medical University of Gdańsk, and then from September 1, 1948 in the Second Department of Internal Medicine of the Faculty of Medicine at the University of Warsaw (from 1950 the Medical University of Warsaw – MUW) as a senior assistant, and later associate professor. The head of both clinics was Prof. Mściwój Semerau-Siemianowski. Working under his direction, Ławkowicz developed various methods of cardiological diagnosis, including catheterization. She was the first to introduce it to routine clinical practice [5].

In the following part of this work, new arguments are presented to award Rutkowski priority in performing the procedure. The basis was the article “Diagnostic value of cardiac catheterization” [6], co-authored by Ławkowicz. This article is based on the text of a paper presented at a Meeting of the Cardiological Section of the Polish Society of Internists on April 2, 1950 in Poznań by Semerau-Siemianowski.

Below are significant fragments of this article, on the basis of which an attempt was made to more accurately estimate the date of the first catheterization by the team of the Second Department of Internal Medicine of the MUW, which included Ławkowicz:

“(…) The first series of cases in which cardiac catheterization was performed at the Second Department of Internal Medicine of the Medical University of Warsaw includes nine patients with congenital heart defects (…).”

“(…) The selection of such a team and the necessary instruments, especially for accurate blood gas testing, became the subject of efforts lasting over a year. Only after this period and after many preparatory attempts did systematic cardiac catheterization begin in the Second Department of Internal Medicine of the Medical University of Warsaw, with the participation of doctors specializing in surgery, cardiology, pediatrics, radiology, and physiology, as well as a chemical engineer. In less than 3 months, 10 patients [one of whom died – R.R.] with congenital heart defects were examined on the basis of the most significant diagnostic indications in this type of patient.”

Notably, the article uses the term: “Second Department of Internal Medicine of the Medical University of Warsaw”. The transformation of the Faculty of Medicine of the University of Warsaw into the Medical University of Warsaw took place in 1950, which suggests that the first catheterizations were performed in that year.

Table 1 of the aforementioned article [6] provides a list of the first catheterized patients, each assigned a ledger number. In 3 patients, this number has the form XXXXX/50, indicating that they were catheterized in 1950. Regarding the remaining 6 patients, the ledger number does not contain data regarding the year. Assuming the earliest date for starting catheterizations, the 3 patients from 1950 were catheterized in January of that year. According to the article [6], the remaining 6 should have been catheterized in November-December 1949 so as to meet the condition of 3 months for catheterization of all patients (November 1949 to January 1950).

The first mention of the Cardiac Catheterization Laboratory appears in the 1949/50 Report of the Second Department of Internal Medicine of the MUW [7], which is consistent with the reasoning conducted above. It should be noted that by this time a year had already passed since Rutkowski performed the procedure [3]. Thus, the question arises why the literature lists 1948 as the year of establishment of the Cardiac Catheterization Laboratory and the first catheterization by Ławkowicz. It appears that the date of establishment of the Cardiac Catheterization Laboratory (1948) and the first catheterization was erroneously conflated with Semerau-Siemianowski’s appointment as head of the Second Department of Internal Medicine of the MUW (then the University of Warsaw) on September 1, 1948 and the beginning of work by Ławkowicz. Therefore, 1948 was accepted in the literature as the year of establishment of the Cardiac Catheterization Laboratory, which is inconsistent with the 1949/1950 Report of the Second Department of Internal Medicine of the MUW [7].

To summarize – three main facts indicating that the first cardiac catheterizations were performed by Ławkowicz in 1949/50, not in 1948, are as follows:

The facts cited above give Rutkowski priority as the first Polish physician to perform cardiac catheterization in Poland, in November 1948 [1, 3, 4].

The two main candidates for the title of pioneer of cardiac catheterization in Poland are Rutkowski and Ławkowicz. In light of the facts presented in this work, priority should be granted to Rutkowski, who performed it for the first time between November 19 and 30, 1948, at S. Sterling Hospital in Łódź, as a diagnostic procedure before the Blalock-Taussig operation. The exact date of Ławkowicz’s first performance of the procedure has not been published, but the approximate date is 1949. It should be emphasized that Ławkowicz deserves credit for developing, disseminating, and implementing catheterization as a routine clinical practice in Poland [5]. The remaining candidates for the title of pioneer in performing cardiac catheterization in Poland – Juszczyński (1950), Kossakowski and Poradowska (1950), Moll (1954), Kustrzycki (1955) – cannot be considered as serious contenders, as their achievements took place significantly later than those of Rutkowski and Ławkowicz (Supplementary material).