Auscultatory and Phonocardiographic Findings in Ventricular Septal Defect

Abstract

The phonocardiogram was studied in 93 patients whose ventricular septal defect was completely closed at open-heart surgery. The chief aim was to correlate the phonocardiographic findings with the presence and extent of pulmonary vascular disease, as measured by the postoperative pulmonary artery pressure. The systolic murmur of the ventricular septal defect proved to be an excellent guide to the severity of pulmonary vascular disease. With a pansystolic murmur there was rarely severe pulmonary vascular disease, but with a short ejection murmur moderate or severe pulmonary vascular disease was always present. The systolic thrill was weak or absent in 26 patients, and 80 per cent of these had an anatomic complication or severe pulmonary hypertension. The mitral diastolic murmur was not a good guide to the severity of pulmonary vascular disease. An associated patent ductus arteriosus gave rise to an early diastolic murmur, never to a continuous murmur, and on auscultatory grounds it could not reliably be distinguished from pulmonary or aortic incompetence. The degree of splitting and the intensity of the second heart sound correlated well with the presence and severity of pulmonary vascular disease. Pulmonary stenosis produced characteristic auscultatory features. A pulmonary ejection click usually indicated the presence of moderate or severe pulmonary vascular disease.