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IN MEMORY OF PROFESSOR INGE EDLER

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IN MEMORY OF

PROFESSOR INGE EDLER

In 1953, Inge Edler was in charge of the Cardi-ology Department at the University Hospital, Lund, Sweden and was in the position responsible for the preoperative diagnosis of heart disease. At that time, cardiac catheterization and contrast x-rays of the he-art failed to give enough data for a correct appraisal of the status of the mitral valve. Since a correct diag-nosis is of great importance before an operation, Ed-ler felt strongly the inadequacy of the existing met-hods. This concern caused him to look for a new non-invasive alternative, which the throught might resemble some kind of a radar.

At the same time Carl Hellmuth Hertz, the son of the famed Nobel Laureate Gustav Hertz, was mor-king as a graduate student at the nuclear physics de-partment of the University of Lund. Because of this interest, he also studied ultrasound. He was acquain-ted with the ultrasonic reflectoscope developed for nondestructive materials testing. An ultrasonic ref-lectoscope was borrowed from the Tekniska Ront-gen-centralen, a company in the nearby town of Malmo, which specialized in nondestructive testing. With the equipment, they were able to obtained well-defined echoes on the CRT screen moving synchronously with his heart beat.

Since Hertz’s father had been the director of the Siemens Research Laboratory before the end of the war, they were able to contact director Wolfgang Gellinek of the Siemens Medical Branch in Erlangen, Germany, to borrow one of their Siemens reflectos-copes. Edler and Hertz received the reflectoscope in October 1953 and set to work on it immediately.

Edler finally established the characteristic motion pattern for the anterior leaflet of the mitral valve. He compared the shape of the fast moving echoes in pa-tients with enlarged hearts due to mitral stenosis du-ring cardiac operations, and found empirically the shape correlated well with the severity of the steno-sis. By early 1955, Edler had so much evidence of this relationshixp that the relied on ultrasound alone for the diagnosis of mitral stenosis. The typical motion patterns of other heart valves, pericarditis, tumors, and thrombosis in the left atrium showed up in the-ir recordings and were identified by close cooperati-on with Dr. Olle Dahlback’s heart surgery group. The advent of a barium titanate transducer produced by Siemens in Germany in 1958 was an important ad-vance for the group and had enabled them to study not only the normal mitral valve but also many other heart structures.

At that time Professor Lars Leksell head of the de-partment of neurosurgery at Lund, had made serious efforts to find a new tool for diagnosing subdural he-matoma caused by a blow against the head. In 1950 the borrow a Kelvin-Hughes Mark 2B flow detector. Experience with this instrument agreed with similar futile efforts by Turner at the Royal Cancer Hospital in Marsden, England. Leksell soon returned the Mark 2B reflectoscope. He borrowed elder’s Siemens ref-lectoscope and was able to detect a clear displace-ment of the midline echo. He continued his investi-gations with a Kelvin Hughes Mark 4 instrument, and 1957 switched to a single transducer Krautkra-mer USIP 9.

Alf Sjovall, then professor of obstetrics and gyne-cology, agreed with Leksell and elder in 1957 (over the lunch table) that the usefulness of the echo met-hod in early pregnancy should be investigated. He therefore encouraged one of his younger collegues, Bertil Sunden, to investigate a number of pregnanci-es with the Krautkramer echoscope. Profpregnanci-essor Ian

Anadolu Kardiyoloji Dergisi

Ana Kar Der, Cilt: 1, Say›: 3, Eylül 2001

Anatol J Cardiol, Vol: 1, No: 3, September 2001 T h e A n a t o l i a n J o u r n a l o f C a r d i o l o g y

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Donald’s description of an echoscope generating a two-dimensional display in 1958 immediately stimu-lated Sjovall’s interest. He sent Bertil Sunden on a three-week visit to Donald and the Smith ›ndustrial Division in Glasgow. His work at Donald’s depart-ment had resulted in the shipdepart-ment of the second ge-neration Diasonograph® to Lund, with which he produced his doctoral thesis on the use of ultraso-und in Obstetrics and Gynecology, and reported his experience on 400 cases of pelvic pathologies. His papers although less well known than those of Do-nalds actually furnished some very important fin-dings and images in the early development of pelvic and Obstetric ultrasonography. Sunden also studied the possible harmful effects of ultrasound on preg-nant rats, and did not find any. Sunden’s thesis was published in an English translation in the Acta Obs-tetrica et Gynecologica Scandinavica as a 180 pages supplement in 1964. This consituted as the earliest “text-book” on ultrasonography in Obstetrics and Gynecology, covering equipmenment, examination techniques, biological effects and A-scan images.

In 1953, the first ultrasound heart examination in the world was perormed in Lund. The pioneers be-hind echocardiography were Professors Inge Edler, cardiologist, and Helmuth Hertz, physicist. They bor-rowed equipment from the ship-building industry, where ultrasound was used to test construction ma-terials. It soon became apparent that ultrasound co-uld be used for the diagnosis of heart diseases. Ot-her scientist in Lund, like obstetricians and gynaeco-logists, were also among the first in the world to ta-ke advantage of ultrasound technology. In the 1960s, Doppler echocardiography was developed in Lund, and another invention of Professor Hertz’s, the ink jet printer, came in handy in the continued development of colour Doppler, which is a method of determining the direction of the blood flow. Pedi-atric cardiologists in Lund were quick to adopt echo-cardiography, which is one reason why Lund has be-come a national centre for child heart surgery.

Even today, the faculty has a leading position in-ternationally in ultrasound research. This is apparent at the Department of Obstetrics and Gynaecloogy in Malmö, where scientists have perfected a technique for measuring the blood flow in the foetus by means

of ultrasound colour Doppler. The method is the most sensitive indicator of foetal health and can be used to monitor the growth of the feotus. Medical technologits also ase ultrasound colour Doppler to measure blood flow in order to examine the elas-ticity of the walls of blood vessels. Early signs of

ar-terisclerosis may thus be found, which is important for the prevention of stroke. Dynamic examinations by means of magnetic resonance imaging, com-puterized tomograp9hy and different radioactive iso-topes are becoming increasingly important in imag-ing diagnostics. The most modern magnetic camera of all has recently been installed at the Lund Univer-sity Hospital. It can even generate pictures of throught processes in the brain. Radiologists in Mal-mö are world leaders in the development of tissue compatible contrast media.

Lars Edler

Professor of Biological Oceanography

Anadolu Kardiyoloji Dergisi

Ana Kar Der, Cilt: 1, Say›: 3, Eylül 2001

Anatol J Cardiol, Vol: 1, No: 3, September 2001

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