Congenital
Defect
Typical
Auscultatory Features
Diagnostic Echocardiographic and
Doppler Echocardiographic Features
Patent Ductus ArteriosusContinuous heart murmur with maximal intensity over the left cranial dorsal cardiac base.Continuous retrograde flow from the patent ductus arteriosus into the pulmonary artery.
Ventricular Septal DefectSystolic murmur with maximal intensity over the right ventral precordium; less often maximal intensity is over the pulmonic valve area and pulmonary artery.The septal defect can often be imaged in multiple imaging planes. Abnormal, generally high velocity, systolic flow across the septal defect is evident.
Atrial Septal DefectSystolic murmur with maximal intensity over the pulmonic valve area and pulmonary artery. The second heart sound may be widely split.The septal defect can generally be imaged in multiple imaging planes. Abnormal blood flow may be identified across the septal defect into the right atrium.
Pulmonic StenosisSystolic murmur with maximal intensity over the pulmonic valve area and pulmonary artery.Abnormal pulmonary valve and /or subvalvular anatomy. Sudden acceleration of blood flow in the right ventricular outlet with turbulent, high velocity systolic flow across the pulmonary valve and into the main pulmonary artery.
Valvular and Subvalvular Aortic StenosisSystolic murmur with maximal intensity over the subaortic or aortic valve area and radiating into the ascending aorta. The murmur may also be prominent over the right cranial thorax.Abnormal subvalvular or aortic valvular anatomy may be evident. Sudden acceleration of blood flow into the left ventricular outflow tract with turbulent, high velocity systolic flow across the aortic valve and into the ascending aorta. Concurrent aortic regurgitation is usually present.
Mitral Valve DysplasiaSystolic murmur with maximal intensity over the left apex and mitral area.Abnormal anatomy of the mitral valve apparatus. High velocity retrograde systolic flow across the mitral valve into the left atrium. Concurrent mitral valve stenosis may be present.
Tricuspid Valve DysplasiaSystolic murmur with maximal intensity over the tricuspid valve area.Abnormal anatomy of the tricuspid valve apparatus. High velocity retrograde systolic flow across the tricuspid valve into the right atrium. Concurrent tricuspid valve stenosis may be present.
Right to Left Cardiac ShuntVariable—a systolic murmur at the left base is often detected; cyanosis is an important clinical sign.Abnormal anatomy related to the cardiac malformations examples include: tetralogy of Fallot, patent ductus arteriosus with pulmonary hypertension, pulmonary or tricuspid valves stenosis with atrial septal defect. Right to left shunting may be documented by Doppler techniques and/or by contrast echocardiography.