Continuous murmurs in cyanotic congenital heart disease

Continuous murmur--the auscultatory expression of a variety of pathological conditions

Continuous murmur is a peculiarity of cardiovascular auscultation, relatively rare, which often hides complex cardiovascular diseases. This article is a review of literature data related to the continuous murmurs accompanied by commenting and illustrating them through our own cases.Recognizing of a continuous murmur and understanding the cardiovascular pathologies that it can hide, is a challenge in current practice.

The acquired nonprecordial peripheral pulmonary murmur of pulmonary embolism

Two patients had noninvasive and invasive findings consistent with massive pulmonary emboli. Both patients had an acquired nonprecordial peripheral pulmonary murmur on physical examination. One patient also demonstrated a wide, fixed-split second heart sound in addition to the acquired murmur. Both of these physical findings have rarely been reported; however, when present, both the acquired nonprecordial murmur and the widely split second heart sound seem to be associated with extensive and massive pulmonary embolism and, when occurring together, are almost pathognomonic for pulmonary embolism.

Congenital extracardiac shunts with tetralogy of Fallot

Congenital extracardiac shunts in tetralogy of Fallot may significantly alter the history and clinical findings and also have significant management implications. An unusual variant of severe tetralogy of Fallot in a 54-year-old man enabled long survival with minimal symptoms. The patient had pulmonary valvular and infundibular stenosis, a large ventricular septal defect, an overriding aorta, and large volume systemic-to-pulmonary artery shunting from his right internal mammary and accessory internal mammary arteries to his right pulmonary artery.

Auscultatory and phonocardiographic manifestations of isolated stenosis of the pulmonary artery and its branches

Images

Phonocardiographic findings in persistent truncus arteriosus

Images

Absent sixth aortic arch: a form of pulmonary atresia

Images

Peripheral pulmonary artery murmur of atrial septal defect

Images

Persistent Truncus Arteriosus

The clinical, hemodynamic, and autopsy data on 19 patients with a diagnosis of persistent truncus arteriosus have been presented.

A proposed clinical classification, dividing the patients into types I and II only, with exclusion of type IV, provides a uniform clinical profile. The patients, as a rule, are small infants with a large left-to-right shunt, minimal cyanosis, wide pulse pressure, left or combined ventricular hypertrophy, and congestive heart failure, and resemble patients with a ventricular septal defect or patent ductus arteriosus.

At cardiac catheterization distinct but slight differences in pressures or saturations between pulmonary arteries and "ascending aorta" do not exclude the diagnosis of persistent truncus arteriosus.

The prognosis is uniformly poor. Most infants die in congestive heart failure within the first 6 months of life, others develop pulmonary vascular obstructive disease in later years.