The history of echocardiography.

Following a brief review of the development of medical ultrasonics from the mid-1930s to the mid-1950s, the collaboration between Edler and Hertz that began in Lund in 1953 is described. Using an industrial ultrasonic flaw detector, they obtained time-varying echoes transcutaneously from within the heart. The first clinical applications of M-mode echocardiography were concerned with the assessment of the mitral valve from the shapes of the corresponding waveforms. Subsequently, the various M-mode recordings were related to their anatomical origins. The method then became established as a diagnostic tool and was taken up by investigators outside Lund, initially in China, Germany, Japan and the USA and, subsequently, world-wide. The diffusion of echocardiography into clinical practice depended on the timely commercial availability of suitable equipment. The discovery of contrast echocardiography in the late 1960s further validated the technique and extended the range of applications. Two-dimensional echocardiography was first demonstrated in the late 1950s, with real-time mechanical systems and, in the early 1960s, with intracardiac probes. Transesophageal echocardiography followed, in the late 1960s. Stop-action two-dimensional echocardiography enjoyed a brief vogue in the early 1970s. It was, however, the demonstration by Bom in Rotterdam of real-time two-dimensional echocardiography using a linear transducer array that revolutionized and popularized the subject. Then, the phased array sector scanner, which had been demonstrated in the late 1960s by Somer in Utrecht, was applied to cardiac studies from the mid-1970s onwards. Satomura had demonstrated the use of the ultrasonic Doppler effect to detect tissue motion in Osaka in the mid-1950s and the technique was soon afterwards applied in the heart, often in combination with M-mode recording. The development of the pulsed Doppler method in the late 1960s opened up new opportunities for clinical innovation. The review ends with a mention of color Doppler echocardiography. (E-mail:

[History of atrial fibrillation]. / Zur Geschichte des Vorhofflimmerns.

The authors review the history of atrial fibrillation, the most frequent clinically observed cardiac arrhythmia. A French "clinicopathologist", Jean Baptist de Sénac (1693-1770), was the first who assumed a correlation between "rebellious palpitation" and a stenosis of the mitral valve. From an analysis of simultaneously recorded arterial and venous pressure curves, the Scottish Sir James Mackenzie (1853-1925) demonstrated that a presystolic a wave cannot be seen on the jugular phlebogram during "pulsus irregularis perpetuus". The first human ECG depicting atrial fibrillation was published by Willem Einthoven (1860-1927) in 1906. The proof of a direct connection between absolute arrhythmia and auricular fibrillation was established by two Viennese physicians, Rothberger and Winterberg. The major discoveries relating to the pathomechanism and the clinical features of atrial fibrillation in the 20(th) century stemmed from the scientific activities of Karel Frederik Wenckebach, Sir Thomas Lewis, Gordon Moe, and Maurits Allessie.

[History of atrial fibrillation]. / A pitvarfibrilláció története.

The authors review the history of atrial fibrillation, the most frequent clinically observed cardiac arrhythmia. A French "clinicopathologist", Jean Baptist de Sénac (1693-1770), was the first who assumed a correlation between "rebellious palpitation" and a stenosis of the mitral valve. From an analysis of simultaneously recorded arterial and venous pressure curves, the Scottish Sir James Mackenzie (1853-1925) demonstrated that a praesystolic a wave can not be seen on the jugular phlebogram during "pulsus irregularis perpetuus". The first human ECG depicting atrial fibrillation was published by Willem Einthoven (1860-1927) in 1906. The proof of a direct connection between absolute arrhythmia and auricular fibrillation was established by two Viennese physicians, Rothberger and Winterberg. The major discoveries relating to the pathomechanism and the clinical features of atrial fibrillation in the 20th century stemmed from the scientific activities of Karel Frederik Wenckebach, Sir Thomas Lewis, Gordon Moe and Maurits Allessie.

The birth of intracardiac surgery: a semicentennial tribute (June 10, 1948-1998)

On June 10, 1948, Charles Philamore Bailey, of Philadelphia, auspiciously performed the first anatomically conceived and digitally guided operation inside the heart: the first successful intracardiac operation. The patient, Claire Ward, was a 24-year-old woman afflicted with severe mitral stenosis. Dwight E. Harken and Russell C. Brock performed their own mitral operations very soon after Bailey, using new variations of methods that had been discarded about two decades earlier; they soon adopted the logical anatomic approach. This threesome, with the added contributions of Robert P. Glover--Bailey's partner at the time, in the role of respected and convincing teacher--opened the floodgates upon a decade of so-called closed heart surgery. These accomplishments, added to the earlier successes with the patent ductus, aortic coarctation, and "blue babies," justified and strengthened the demand for precise diagnosis in cardiology--at that time a languishing specialty--and brought to the fore the indisputable requirement to operate inside the heart with maximal control. This essay calls attention to the semicentennial of that seminal event and reviews the origins of surgery for mitral stenosis.

The relief of mitral stenosis. An historic step in cardiac surgery.

Significant progress has been achieved in cardiac surgery in the last 50 years. Mitral valve surgery (especially for the relief of mitral stenosis) has paralleled the innovations and trends of cardiac surgery and often has served as the benchmark of the latest procedures and techniques. A chronological survey of mitral valve surgery is presented, with emphasis on parallels to cardiac surgery in general and with highlights of key figures and events that have conclusively altered the surgeon's approach to and success with cardiac dysfunction. A few surgeons promulgated the idea of cardiac surgery in the late 19th century, but mitral valve surgeries were not performed in earnest until Souttar's and Cutler's initial attempts in the 1920s and were not successful on large groups of patients until Bailey and Harken made independent breakthroughs in the 1940s, finally laying to rest the idea of the "inviolable heart." Cardiopulmonary bypass provided cardiac surgeons with the time to implant mechanical and bioprosthetic valves for palliative benefit to patients. The "perfect" valve has yet to be found, but the Starr-Edwards mechanical valve since its inception in 1961 has been one of the most successful and widely used prosthetic valves. Gradual improvement in surgical technique and growing knowledge of valve function enabled the re-emergence of mitral valve repair in the 1980s as the preferred surgical method of treating mitral stenosis. In the last 10 years, mitral valve balloon dilation has provided a nonsurgical technique for relief of stenosis and represents the broader trend towards interventional techniques.

The first successful surgical treatment of mitral stenosis: the 70th anniversary of Elliot Cutler's mitral commissurotomy.

In 1923 Elliot Carr Cutler, in conjunction with his cardiology colleague, Samuel Levine, performed a closed transventricular mitral commissurotomy with a tenotomy knife on a 12-year-old patient dying of rheumatic mitral stenosis at the Peter Bent Brigham Hospital. This operation was carried out after several years of experimentation regarding resuscitation of the heart, appropriate incisions, and the pathophysiology of mitral stenosis. The interest in mitral stenosis was rampant at the time because of the huge number of patients suffering from this public health problem. The patient survived and went on to die of pneumonia 4 years postoperatively. Subsequent to this, Cutler performed seven more operations using his new cardiovalvulotome, which was to create controlled mitral regurgitation. Unfortunately, this concept did not promote long-term success and a moratorium for these operations was called in 1929. Nevertheless, this pioneering effort in 1923 was the first successful operation to treat valvular heart disease by a surgical technique.