The continuous murmur of persistence of the ductus arteriosus – an historical review

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Abstract
The history of the continuous murmur of persistent ductus arteriosus (PDA) dates from the early years of auscultation. Skoda paved the way by describing the continuous murmur as a feature of an arteriovenous fistula. Williams and Bernutz in 1847 were the first to correlate the murmur with the post-mortem demonstration of PDA. Thereafter continuous murmurs were uncommon in the few case reports of PDA. Gerhard in 1867 suggested turbulence in the pulmonary artery as its likely explanation. Gilbert in 1886 provided the first full description of the murmur, likened it to that of an arterio-venous fistula and, like Williams, pointed out its diagnostic value. Nevertheless, dependence on autopsy for diagnosis retarded understanding of the continuous murmur until 1898 when Gibson, unlike previous authors, outlined his description of the murmur on the basis of repeated clinical observations. He illustrated its precise character, gave the first clear account of its causation and established that a confident diagnosis could be made on clinical grounds with later autopsy proof. He went on to emphasize its frequency as the typical murmur ofPDA. This clear understanding of the continuous murmur anticipated the findings at cardiac catheterization, increased the scope of diagnosis and thus proved the need and facilitated the assessment for surgical treatment.

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