Continuous murmur in pulmonary atresia with reference to aortography

The site and variation of a continuous murmur and its correlation to the anatomy of aorto-pulmonary communications were studied in 32 patients with pulmonary atresia and large ven-tricular septal defect. A continuous murmur localized beneath the left clavicle was always associated with a persistent duct. When a continuous murmur beneath the left clavicle and at another site was heard in the absence of transposition, large collateral arteries but not a duct were the cause. A continuous murmur in the right upper chest was always associated with a right aortic arch and large col-lateral arteries perfusing the right upper lobe. It is shown that clinical examination in pulmonary atresia gives additional information about the anatomy of the aortopulmonary communications, which helps in planning catheterization and angiocardiography. A continuous murmur is commonly present in patients with pulmonary atresia associated with a large ventricular septal defect. Some-times it is caused by a persistent ductu