Some variations in the clinical picture of congenital defect of the interventricular septum

Abstract

In seven patients the diagnosis of ventricular septal defect as an isolated lesion was established by the clinical picture and by cardiac catheterization. An additional patient resembled ventricular septal defect clinically but was found on catheterization study to have the tetralogy of Fallot. In the seven instances of isolated ventricular septal defect, the following clinical picture was found: 1. 1. There was in each patient a systolic cardiac murmur. This was of maximal intensity in the second, third or fourth intercostal spaces adjacent to the sternum. A thrill was felt in systole in five of seven patients. No diastolic murmur was heard at the left sternal border, but a short apical diastolic murmur or gallop was heard in three patients. 2. 2. The pulmonic second sound varied from diminution to accentuation with splitting. 3. 3. The pulmonary vascular markings varied from normal to accentuation with intrinsic pulsation. Intrinsic pulmonary hilar pulsations were seen fluoroscopically in two instances and were questionable in a third. 4. 4. The cardiac silhouette on x-ray was virtually normal in two; showed right ventricular hypertrophy in two; in three showed combined hypertrophy of both ventricles, chiefly the left. 5. 5. The electrocardiogram was normal in three instances and showed incomplete right bundle branch block in four instances. 6. 6. Cyanosis and clubbing were absent in all patients. All save one had a normal arterial oxygen saturation.