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The Catheterization Lab

The Catheterization Lab and Richard Bing

The success of the blue baby operation brought international renown to Hopkins; along with this renown came many new cardiac patients with a variety of rare conditions. Accurate diagnosis was essential before proceeding with heart surgery.

In 1945, Alfred Blalock asked his colleague Dr. Richard J. Bing to set up a laboratory for the physiological and diagnostic study of congenital heart disease. This lab, the first to specialize in congenital heart disease and cardiac anomalies, would lay the foundation for a golden age of cardiology in the late 1940s.

Richard J. Bing

Dr. Richard J. Bing, 1909-2010. Photograph of Richard Bing seated at his desk, circa 1965.

Prior to this period, methods used for diagnosing congenital heart disease were limited to physical examinations, patient histories, electrocardiography, and early fluoroscopy. Bing pioneered the use of cardiac catheterization, particularly for diagnosing heart abnormalities in children. In postoperative studies, he evaluated the effectiveness of specific procedures, crucial to finding the best techniques when the field was in its infancy.

Catheterization involves passing a catheter from a blood vessel in the arm, leg, or neck into the beating heart to study arteries, valves, and chambers. Bing, who learned the procedure from researchers at Columbia and New York University, performed his first right atrial catheterization at Hopkins in 1945. The laboratory’s location on the surgical floor, Halsted III, allowed constant feedback between laboratory findings and clinical decision-making.

Richard Bing performing a procedure on a child in the cardiac catheterization lab of the Johns Hopkins Hospital

Richard Bing performing a procedure on a patient in the cardiac catheterization laboratory of the Johns Hopkins Hospital

By 1947 Bing had catheterized over 100 patients with Tetralogy of Fallot. Together, Bing, Blalock, and Taussig identified and published on at least 20 different types of congenital heart defects. These included transposition of the great arteries, Ebstein’s malformation, Eisenmenger’s complex, atrial septal defect, aortic valve atresia, and the eponymous Taussig-Bing anomaly. Bing also created a classification of congenital heart defects that has served as an important reference for physicians. His basic research on cardiac metabolism revealed unknown facts about the operation of the human heart: how oxygenation and blood flow change in disease and health, and its remarkable capacity to adapt to and overcome handicaps.

Heart Sound Lab 58-03 (1955). Tetralogy of Fallot; post-operative Blalock-Taussig anastomosis.

Post-operative Tetralogy of Fallot audio recording from the Johns Hopkins Heart Sounds Lab, 1955. EKG and the analysis of heart sounds were used for diagnosis before the advent of catheterization, and continue to be clinically valuable tools.

The Catheterization Lab