Sulpice Antoine Fauvel was a French physician and correctly described the diastolic murmur of mitral stenosis that he called presystolic murmur. He reported his findings in a brief communication of sixteen pages that was published in 1843. In this work, he provided a detailed description of the clinical findings with particular emphasis on auscultatory findings, postmortem examination and clinico-pathological correlations.
Fauvel's observation was based on a series of four patients with mitral stenosis. The age of the patients ranged from 32 to 50 years old and they suffered from rheumatic heart disease. Postmortem examination was performed in three cases: two patients showed no insufficiency; the third showed associated mitral regurgitation and aortic stenosis. The fourth patient was alive at the time he wrote the article.
The following is a brief description of these cases:
Case 1: A 50 year-old female, admitted with right hemiplegia. On auscultation rather loud, rasping murmur was heard, having its maximum of intensity at the level of the fifth rob, to the left of the nipple. This murmur started in the pause following the second sound, and terminated at the instant when the first sound was heard. It diminished in intensity towards the right and towards the base of the heart. The pulse was small, intermittent and irregular. There was no edema. After the patient's death, the mitral orifice was found to be so narrowed as to scarcely allow the passage of the index finger.
Case2: A 32 year-old female, suffering from puerperal meritis, with a pulse of 120. On auscultation, there was heard over the precordial region a rough ("rugueux") murmur, starting before the first sound, and terminating with it, so as to give it a very hoarse character ("un timbre fortement enroue"). This murmur was loudest at the apex. The patient died three or four weeks later; before death the bruit preceding the first sound presented some irregularities in regard to its intensity. The mitral orifice was found to be so narrow as not to admit the extremity of the little finger.
Case 3: A 35 year-old female, admitted into the Hotel-Dieu with erysipelas. On auscultation a marked rasping murmur was heard preceding and obscuring the first sound at the apex of the heart and to the left of it. At the base another rasping murmur, following the first sound, was audible. After death the mitral orifice was found to be funnel-shaped, and so narrow as scarcely to admit the finger. The aortic valves were also thickened and narrowed.
Case 4: A 32 year-old male, suffering from cardiac "dropsy", with much oppression of the chest. A rasping murmur was heard, starting immediately after the second sound, and running up to the first sound.
In the conclusion of his paper, Fauvel noted: "I conclude from the facts stated in this memoir that a morbid presystolic bruit localized at the apex of the heart is, in the existing state of science, the stethoscopic sign which points with the greatest probability to contraction of the mitral orifice. I do not say a certain sign; for the facts on which this conclusion is based are so few that it can as yet only be regarded as provisional, and as needing to be confirmed by new observations."
Here is the complete original text of Fauvel's article:
Following the discovery of the stethoscope, the auscultatory characteristics of different valvular diseases became of great interest and a major field of research. The auscultatory features of mitral stenosis were, however, a confusing battlefield of opinion and Fauvel's contribution was recognized as a milestone in the history of this disease.