Endocardial and Intimal Lesions (Jet Impact) as Possible Sites of Origin of Murmurs

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Abstract
High-velocity streams (jets) of blood are a hemodynamic characteristic when a high-pressure gradient exists across a small orifice. If such jet streams strike the wall of the receiving compartment, be it either cardiac chamber or blood vessel, the focal trauma causes a fibrous reaction designated as a jet lesion. At the site of impact where jet lesions are formed, the jet stream is either arrested or deflected and imparts energy to the area which may vibrate and give rise to an audible murmur. Jet lesions may be considered as designating possible sites of origin of murmurs in whole or in part, and in this regard may be utilized in the explanation of the particular positions of the maximal intensity of murmurs recorded during life. Random examples in support of this proposition are the systolic murmurs heard at maximal intensity in the left subclavicular area in some patients with congenital pulmonary valvular stenosis; in the left scapular area in patients with mitral regurgitation in which it is believed the anterior leaflet was of inadequate length to meet the posterior leaflet; and in the aortic area in patients with mitral regurgitation resulting from rupture of the chordae to the posterior leaflet which then behaves as a hood-like baffle directing the regurgitant stream forward and to the right.

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