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Continuous murmur in pulmonary atresia with reference to aortography.

The site and variation of a continuous murmur and its correlation to the anatomy of aortopulmonary communications were studied in 32 patients with pulmonary atresia and large ventricular 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 collateral 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.