Auscultatory Findings in Patients with a Small Ventricular Septal Defect

The auscultatory and phonocardiographic findings were analyzed in 21 cases of small ventricular septal defect. Eleven patients had identical right ventricular and pulmonary artery systolic pressures, whereas in nine a minimal systolic gradient across the infundibulum of the right ventricle was demonstrated. One half of the patients, with or without an infundibular gradient, had a pansystolic plateau-shaped murmur. Several patients, mostly those with an infundibular gradient, had a distinct diamond-shaped murmur. A few children showed an early systolic decrescendo murmur. Appreciable, even wide splitting of the second sound with inspiratory widening, was demonstrated. It is proposed that a sharp differentation between "ejection" and "regurgitant" systolic murmurs may be difficult under certain circumstances. Furthermore, it is suggested that the definition of an "innocent" or "functional" murmur may depend on the sensitivity of the diagnostic methods used.