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Valvular pulmonic stenosis: Auscultatory and phonocardiographic characteristics

1958; Elsevier BV; Volume: 56; Issue: 6 Linguagem: Inglês

10.1016/0002-8703(58)90198-4

1097-6744

Lamar Crevasse, R.Bruce Logue,

Phonocardiography and Auscultation Techniques

1. Mild pulmonic stenosis has an early systolic ejection sound and a characteristic mid-systolic ejection murmur followed by pathologic splitting of the second sound. The aorticopulmonic interval by phonocardiography is 0.03 to 0.06 second, and right ventricular systolic pressure is usually less than 60 mm. Hg. 2. Moderate pulmonic stenosis has an aorticopulmonic interval of 0.06 to 0.10 second, and right ventricular pressure ranges from 60 to 100 mm. Hg. 3. Severe pulmonic stenosis has a late systolic ejection murmur which may override the aortic second sound. The pulmonic second sound is markedly delayed in closure, and an ejection sound may or may not be present. The aorticopulmonic interval is usually 0.10 to 0.14 second, and right ventricular systolic pressure is more than 100 mm. Hg. There is the usual overlap of the groups. 4. We have been able to further corroborate Leatham's observations that there is a close linear relationship between the degree of stenosis as reflected by right ventricular systolic pressure and the delay in closure of the pulmonic valve. This is a valuable aid in assessing the status of pulmonic stenosis, and is more reliable than using the height of the R wave in Lead V1. 5. We believe that the pulmonic ejection sound which disappears with inspiration and reappears with expiration is related to mechanical alterations in the initial tension of the poststenotic pulmonary artery, owing to the respiratory cycle. The aortic ejection sound varies little with the respiratory cycle. 6. When a ventricular filling sound (S3) is present with moderate to severe pulmonic stenosis, an atrial septal defect and/or anomalous pulmonary venous drainage is usually associated with it. 7. Aortic stenosis and ventricular septal defect both may present as stenotictype murmurs, maximal in the second left intercostal space, simulating pulmonic stenosis. The graphic character of the systolic murmur, second sound, and ejection sounds are the best means of differentiation, because location, electrocardiography, and x-ray may be of little value in the mild defects.