As we celebrate the 50th anniversary of the founding of echocardiography this year, it is appropriate that we recognize both the inventors and the inventions that have made echocardiography the robust imaging technique it is today. At the same time, it is interesting to put them into context by noting what other events were occurring in the world of cardiology, medicine, and engineering. Here then, in chronological order, is a brief history of echocardiography. Although there are many early discoveries and many starting points of echocardiography, Johann Christian Doppler’s 1842 description of the effect which bears his name is perhaps the best. He noted that “the color of luminous bodies, just like the pitch of a sounding body, changes with motion of the body to and from the observer.” At the time, cardiology was not a medical specialty; yet in 1844 Bernard performed the first cardiac catheterization—his patient was a horse! Thirty-nine years later, in 1881, Jacques and Pierre Curie (husband of Marie) discovered the principle of piezoelectricity—an electric polarization produced by the compression or the expansion of crystals in the direction of the axis of symmetry. Soon thereafter, Einthoven began experimenting with the string galvinometer, and in 1903 he recorded the first ECG and PQRST waves. In addition to winning the Nobel Prize in 1924, the invention of the electrocardiogram also led to the creation of the specialty of cardiology, in a very interesting way. Possession of and knowing how to use a technology (an ECG machine), rather than a purely cognitive set of skills, defined a physician as a cardiovascular specialist. The first half of the twentieth century saw continued early developments in echocardiography. In 1917 (Jean) Paul Langevin was the first to attempt to use the piezoelectric effect as sonar, to detect U-boats. Unfortunately he succeeded only in heating water and killing fish. In 1941 Karl T. Dussik was the first to attempt to use ultrasound in medicine, although he examined the brain and not the heart. That same year, A. Cournand and D. Richards perfected Werner Forssmann’s 1929 experiment on himself, and invented modern cardiac catheterization, for which they later won the Nobel Prize in 1955. In 1950, W.D. Keidel was the first to use ultrasound on the heart. He reported his (unsuccessful) attempts to measure cardiac volumes by recording synchronous ultrasound and phonocardiograms in a paper entitled: “On a new method for the registration of volume changes of the human heart.” Two years later, J.J. Wild and J.M. Reid and D. Howry and W. Bliss independently developed the first 2-dimensional ultrasound imaging systems, but did not attempt to image the heart. In 1953, Inge Edler (a physician) and C. Hellmuth Hertz (an engineer) borrowed a shipyard sonar machine made by Siemens used for detecting structural flaws in boat hulls. They are credited with performing the first human echocardiogram, which they termed ultrasound cardiography (UCG). Images were crude, but the posterior left ventricular wall and anterior mitral leaflet were visualized (although the valve was initially thought to be the anterior left atrial wall). This was the first successful imaging of any organ for medical purposes, and Edler and Hertz won the Lasker award in 1977 for the invention of medical ultrasound imaging. While Edler continued to be a pioneer in echocardiography, Hertz, whose father won the Nobel Prize in physics, went on to invent the ink jet printer. Hertz also advised Siemens not to bother with cardiac ultrasound because he saw little commercial future in it, although he did stay in the field long enough to invent the first mechanical 2-dimensional cardiac scanner in 1971. Other echocardiography pioneers included Hsu Chih-Chang (China), Sven Effert (Germany), and Schmitt and Braun (Germany). In 1956 S. Satumora, Yoshida, and Nimura were the first to apply the Doppler principle to the use of ultrasound to detect cardiac motion (but not blood flow). That same year, the videotape recorder was invented and Paul Zoll performed the first external defibrillation. The use of cardiac ultrasound was growing; in 1957, the year of Sputnik, J.J. Wild and J.M. Reid identified a myocardial infarction in vitro, using both M-mode and 2-dimensional echocardiograhpy in the US, and published their images in the American Heart Journal. Cardiovascular medicine was thriving as well. In 1958 Sones performed the first selective coronary angiogram, Ross performed the first transseptal catheterization, and Sherry first used streptokinase to treat acute myocardial infarction in 24 patients. To be continued next month…
Read full abstract