Auscultatory Recognition of Aneurysm of the Membranous Ventricular Septum Associated with Small Ventricular Septal Defect

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Abstract
The clinical diagnosis of aneurysmal formation of the membranous ventricular septum associated with a small ventricular defect has been made previously only by means of angiocardiography. Active movement of the aneurysm during cineangiocardiography suggested the possibility of a corresponding auscultatory event. When careful auscultatory and phonocardiographic examinations were performed on 21 patients previously documented as having a small membranous ventricular defect with an associated aneurysm, a distinct early systolic sound was heard in 17 (81%). This sound was "clicky" in quality, confined to a narrow area along the lower left sternal edge, and best heard in expiration. It occurred during the upstroke of the carotid arterial tracing and followed the Q wave by 100 to 130 msec. On the basis of experience with other patients the development of this early systolic sound in a patient with a small ventricular septal defect suggests the diagnosis of associated septal aneurysm, but such a sequence requires confirmation by serial angiocardiography. Aneurysmal formation may be a prelude to spontaneous closure of the septal defect in which case auscultation of an early systolic sound should not only prove to be a valuable diagnostic sign for the clinician but may also be of considerable prognostic significance for the patient.