Harvey Feigenbaum pioneered the echocardiography in the United States and has been called the father of American echocardiography. He became interested in 1963 and his initial investigations were on the use of ultrasound in the diagnosis of pericardial effusion. He also applied this technology to examine the left ventricle and to determine its dimensions, thickness, volume and function.
Feigenbaum made important contributions to the echocardiographic studies of cardiac valves including the mitral valve.
Although the reduced E-F slope was already recognized as a major sign of mitral stenosis, Feigenbaum's experience had shown that some patients with reduced E-F slope did not present with mitral stenosis. In 1972, he published a classic paper demonstrating the importance of abnormal posterior leaflet motion for the diagnosis of true mitral stenosis. In his comments, Feigenbaum wrote:
"...Normally, the two leaflets are virtually mirror images of each other, although in most cases the amplitude of the posterior leaflet is considerably less than that of the anterior leaflet. During opening and closing of the valve, the two leaflets move in opposite directions. In patients with mitral stenosis, however, the posterior leaflet moves in the same direction as the anterior leaflet. The posterior leaflet, of course, does not move with as great an amplitude as the anterior leaflet, but during diastole the distance between the two leaflets is markedly reduced. In patients who have reduced left ventricular filling and a diminished E to F slope but no mitral stenosis, the posterior leaflets retain an essentially normal motion."
Feigenbaum and his team also published for the first time the echocardiographic findings in patients with mitral valve regurgitation with leaflet prolapse. In their artice, these authors wrote:
"With a prolapsed mitral, the onset of systole is normal; however, in midsystole the echoes from both leaflets begin to move downward or posteriorly towards the left atrium...the posterior leaflet moves more than the anteior leaflet and there is separation of the two echoes [posterior leaflet prolapse]. The leaflets move back towards each other just before the onset of diastole."
Harvey Feigenbaum published the first monograph on echocardiography in 1972. This outstanding book has become a classic in cardiology and has been edited multiple times. The chapter on mitral valve, from the first edition, is displayed here.
The technique of ultrasound echocardiogram evolved very rapidly with the addition of two dimensional and Doppler echocardiography. The combination of these two modalities was a significant progress for color flow mapping. Currently, these methodologies are widely used in daily practice and therefore are reviewed in the "Current Status" section.