Auscultatory and phonocardiographic characteristics of supracristal ventricular septal defect.

Abstract

Six cases of supracristal ventricular septal defect, verified by right heart catheterization and left ventricular angiocardiography, are presented. Three of the 6 cases had associated aortic regurgitation both clinically and by retrograde aortography. The diagnosis was verified also by operation in 3 of the cases, and in one of these also by necropsy. This anatomical site of the septal defect gives rise to a different picture on auscultation and by phonocardiography compared to the usual defect. A holosystolic murmur is found which is best heard in the second left intercostal space and which increases in intensity as it approaches the second sound or, alternatively, the systolic murmur is diamond-shaped with its maximum intensity shifted to the right. There is wide splitting of the second sound in expiration (mean o o52 sec.) with pathological attenuation of P2.We showed that significant lengthening of right ventricular isometric contraction and ejection periods with slight shortening of the left ventricular isometric contraction period was the cause of the pathological splitting of the second sound. A haemodynamic explanation for the splitting of the second sound, the pathological attenuation of the pulmonary component, and the unusual morphology of the systolic murmur, is attempted. Subjects and methodsComplete clinical, electrocardiographic, radiological, phonocardiographic, and cardiac catheterization (including left ventriculography) studies were performed in 4 female and 2 male patients between the ages of 9 and 20 years. Retrograde aortography was performed additionally in 3 of them (Cases 4, 5, and 6) in whom there was associated aortic regurgitation. In 2 (Cases 2 and 3) an intracavitary phonocardiogram was also obtained. The clinical diagnosis was verified by operation in Cases 2, 3, and 6 and in one of these (Case 6) also by necropsy.All phonocardiograms were taken on a Sanborn Twin Beam photographic recorder at a paper speed of 75 mm. a second using a logarithmic amplifying system. The recordings were obtained from all valvular areas. An electrocardiographic lead (lead II), indirect carotid pressure pulse, and apex cardiogram from the left ventricle (Benchimol and Dimond, I963; Benchimol, Legler, and Dimond, I963) were used for timing.Right heart catheterization was performed under premedication with pethidine (i mg./kg.) and promethazine (o.5 mg./kg.). A Cournand No. 7 on 11 May 2018 by guest. Protected by copyright.

Doubly Committed Ventricular Septal Defect: Single-Centre Experience and Midterm Follow-Up

“…There are many synonymous names given to this type of VSD, such as supracristal, subarterial infundibular or subpulmonary, or subpulmonic VSD. Clinically, a thrill is present with a holosystolic murmur, diamond shaped and with maximum intensity in the second left intercostal space [3]. Its location adjacent to the arterial valves explains the unique natural history of this defect.…”