THE SOUNDS AND MURMURS IN TRANSPOSITION OF THE GREAT VESSELS

Abstract

Phonocardlograms of 30 patients with transposition of the great vessels were chosen for study because their hearts were subsequently examined at autopsy. Thirteen had no pulmonary stenosis or septal defect other than a small patency of the foramen ovale. All showed an early ejection systolic murmur maximal at or before the mid-point between the onset of the QRS and the second sound. All but 4 showed some splitting of the second sound without diminution of the pulmonary component. All showed an apical flow murmur in diastole. These features taken together are strong evidence of transposition of the great vessels. A patent ductus is usually present but its size and presence cannot be deduced with assurance from the phomocardiogram. Ten patients had transposition of the great vessels with ventricular septal defect. Eight of these were under 4 months of age and the phonocardiograms did not differ significantly from the above. The others were aged 8 and 10 years and showed changes attributed to increasing pulmonary vascular resistance. Three patients had transposition of the great vessels with ventricular septal defect and pulmonary stenosis. In 2 the systolic murmur was of low intensity, probably because of extreme infundibular stenosis located behind the aorta. The other had dextrocardia with valvular stenosis with a loud systolic murmur and late small pulmonary closure sound.