Patent Ductus Arteriosus and Pulmonary Valve Insufficiency; Unusual Clinical Manifestations

¹ Department of Medicine, Indiana University School of Medicine, the Krannert Institute of Cardiology, Marion County General Hospital, Indianapolis, Indiana and Community Hospital of Indianapolis, Indiana

A patient with patent ductus arteriosus is described in whom the combination of pulmonary hypertension and pulmonary insufficiency seem to allow shunting of blood only in diastole. These circumstances produced a peculiar, low-pitched holodiastolic murmur, maximally heard in the second to fourth intercostal space to the left of the sternum. The murmur appeared to be produced by eddy currents in the region of the ductus rather than in the area of the pulmonary valve. The case is reported because of the rarity with which this type of murmur is heard with patent ductus arteriosus.