Auscultatory and phonocardiographic signs of atrial septal defect

The course and management of pulmonary stenosis depends on two main factors, the degree of obstruction to right ventricular outflow and the presence and extent of an over-riding aorta with a ventricular septal defect. This investigation was undertaken to determine how accurately these points could be decided by study of the heart sounds and murmurs. The pulmonary systolic murmur has long been recognized as the most important sign (Peacock, 1866), but the significance of its duration and graphic form has not been widely appreciated. Little attention has been paid to the first heart sound since Petit in 1902 commented on its snapping quality at the base in some cases. The second heart sound at the pulmonary area has been variously described as accentuated, normal, diminished, or absent: this has been due to failure to differentiate between aortic and pulmonary components of the second sound at the pulmonary area as pointed out by Abrahams and Wood (1951). The present investigation shows that the presence or absence of the pulmonary component and its delay in relation to the aortic component are of considerable help in diagnosis. METHOD Seventy patients with pulmonary valvular or infundibular stenosis were studied. The clinical diagnosis was confirmed by cardiac catheterization or angiocardiography in all, and also by operation in thirty-fiv