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February 19, 2017
Echocardiography Inge Edler

Inge Edler (1911-2001)

Edler I, Hertz CH. The use of ultrasonic reflectoscope for the continuous recording of the movements of heart walls. Kungl Fysiogr Sallask Lund Forhandl, 1954, 24:5

Edler I. The diagnostic use of ultrasound in heart disease. Acta Med Scand Suppl, 1955, 308:32

Edler I. Ultrasound cardiogram in mitral valvular disease. Acta Chir Scand, 1956, 111:230

Edler I, Gustafson A, Karlefors T. et al. Mitral and aortic valve movements recorded by an ultrasonic echo method: an experimental study. Acta Med Scand Suppl, 1961, 370:68

The ultrasound technology was first applied in medicine for the detection of brain tumors as early as 1952. Inge Edler and Carl Hertz introduced this methodology for the study of the heart in 1954.  Their fist publication was on the continuous recording of the movements of the heart walls.  This technology was also applied to study cardiac valve motions and for the diagnosis of mitral valve diseases. They used pulse reflected ultrasound and obtained recorded tracings that we now call M-mode type of ultrasound. Mitral valve stenosis was among the first valvular disorders to be diagnosed with this new imaging modality.

In 1955, Edler published a second article entitled "The diagnostic use of ultrasound in heart disease."

In this brief work, He wrote: "It is possible to use ultrasonic reflectoscope for: 1. locating the boundaries between heart-wall and blood 2. locating the heart-walls on living human beings 3. the continuous recording of the movements of the posterior wall of left ventricle and the anterior left atrial wall."

He also mentioned that after additional investigations , he was able to:

"1. locate boundaries between blood and vessel 2. differentiate pure mitral stenosis from mitral regurgitation (Figure 2- shown below) 3. show the movements of the left auricular wall in a case of auricular flutter 4. diagnose thrombosis in the left auricle in cases of mitral stenosis 5. diagnose pericardial effusion."

Edler used extensively this imaging modality to determine the echocardiographic features of mitral valve stenosis. This work appeared in 1956 under the title, "Ultrasound cardiogram in mitral valvular disease."

He examined 100 cases of mitral stenosis and his recordings showed "... decreased amplitude of the movements of the left atrial wall during ventricular diastole due to the resistance of the flow of blood from the left atrium into the ventricle."  In 20 patients who underwent commissurotomy, he observed an increase in the amplitude of the movements of the left atrial wall which corresponded to the dilatation of mitral orifice ( see figure below, I: preoperative recording, II: postoperative recording).

According to Havery Feigenbaum, after improving the sensitivity of the ultrasound instrument, Edler was able to record an echo from the movements of the anterior leaflet of the mitral valve. He, however, did not recognize initially the origin of this echo and attributed it to the movements of the left atrial wall. After several autopsy studies, Edler identified the true origin of this echo which corresponded to the motion of the anterior leaflet. At that point, he correctly recognized that there was a significant difference in the anterior leaflet motion in patients with mitral stenosis compared to those with a normal mitral valve. The criterion used for the diagnosis of mitral stenosis was a reduced rate of mitral valve closure after rapid opening of the valve in early diastolic phase.

Finally in 1961, Edler and his team conducted an experimental study allowing them to determine correctly the movements of the mitral leaflets and the aortic cusps during diastole and systole on echocardiography.



Toward the end of 1950's, several investigators showed a great interest in the application of this new technique and M-mode echocardiography was performed with an increasing frequency for the diagnosis of various cardiac diseases. A decade later, M-mode echocardiography became a major diagnostic tool in cardiology and was being used to determine valvular function, to diagnose pericardial effusion and to identify intracardiac masses.

 

Mount Sinai Library of medicine provided graciously the PDF file of these articles.


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Harvey Feigenbaum


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