Transposition of the Great Arteries

A severe defect with failure of rotation of the great vessels, leaving the aorta to arise from the right ventricle and the pulmonary artery from the left ventricle

Ventricular Septal Defect

Small to moderate

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.

Continuous flow from aorta to pulmonary artery throughout the cardiac cycle when ductus arteriosus does not close after birth

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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