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The severe LV hypertrophy present in systemic hypertension, severe valvular aortic stenosis, and hypertrophic cardiomyopathy is often responsible for a loud S4.
Medical geneticists were studying an inherited heart defect, super valvular aortic stenosis, and found that it is caused by partial deletions of one elastin gene on chromosome 7.
The concept of an apicoaortic conduit to bypass valvular aortic stenosis (AS) was conceived by Carrel in 1910, and performed experimentally by Sarnoff and colleagues on dogs in 1955.