Transposition of the Great Arteries
Ventricular Septal Defect
Small to moderate
Small to moderate
Blood going from a high-pressured left ventricle through a defect in the septum to the lower-pressured right ventricle creates turbulence, usually throughout systole.
General. Intense generalized cyanosis
Location. No characteristic murmur. If a murmur is present, it may reflect an associated defect such as VSD or patent ductus arteriosus.
Radiation. Depends on associated abnormalities
Qitality. Depends on associated abnormalities
Location. Lower left sternal border Radiation. Little
Intensity. Variable, only partially determined by the size of the shunt. Small shunts with a high pressure gradient may have very loud murmurs. Large defects with elevated pulmonary vascular resistance may have no murmur. Grade II-IV/VI with a thrill if Grade IV/VI or higher.
Single loud second sound of the anterior aortic valve
Frequent rapid development of congestive heart failure
Frequent associated defects as described at the left
With large shunts, there may be a low-pitched middiastolic murmur of relative mitral stenosis at the apex.
As pulmonary artery pressure increases, the pulmonic component of the second sounds at the base increases in intensity. When pulmonary artery pressure equals aortic pressure, there may be no murmur, and P2 will be very loud.
In low-volume shunts, growth is normal.
Left-to-right shunt through an opening in the atrial septum, possible at various levels
Qitality. Pansystolic, usually harsh, may obscure Si and S2 if loud enough
Location. Upper left sternal border and to left
Radiation. Sometimes to the back
Intensity. Varies depending on size of the shunt, usually Grade II-III/VL
Qitality. A rather hollow, sometimes machinerylike murmur that is continuous throughout the cardiac cycle, although occasionally almost inaudible in late diastole, uninterrupted by the heart sounds, louder in systole
Location. Upper left sternal border
Radiation. To the back
Intensity. Variable, usually Grade II-III/VI
Qitality. Ejection but without the harsh quality
In larger shunts, congestive heart failure may occur by 6-8 weeks; poor weight gain.
Associated defects are frequent.
Full to bounding pulses
Noticed at birth in the premature infant who may have bounding pulses, a hyperdynamic precordium, and an atypical murmur
Noticed later in the full-term infant as pulmonary vascular resistance falls
May develop congestive heart failure at 4 to 6 weeks iflarge shunt
Poor weight gain related to size of shunt
Pulmonary hypertension affects murmur as above.
Widely split second sounds throughout all phases of respiration, normal intensity
Usually not heard until after age of 1 year
Gradual decrease in weight gain as shunt increases
Decreased exercise tolerance, subtle, not dramatic
Congestive heart failure is rare.
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