Abstract
In 7 patients, isolated subpulmonic ventricular septal defect was identified by selective left ventricular angiocardiography and, in 6, confirmed by direct surgical observation. Each of the 7 patients exhibited characteristic auscultatory and phonocardiographic findings signaling the presence of this lesion. The murmur of subpulmonic ventricular septal defect was pansystolic and crescendo-decrescendo in configuration. Maximal intensity appeared in the first and second left intercostal spaces with preferential radiation of the murmur upward toward the left clavicle and jugular notch. The absence of pure right ventricular hypertrophy in the electrocardiogram aided in distinguishing the murmur from that associated with isolated valvular pulmonary stenosis. Selective left ventricular angiocardiography is currently the most valuable clinical modality for positive identification of the subpulmonic ventricular septal defect.
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