April 1988

Still's Murmur-Reply

Author Affiliations

Texas Children's Hospital 6621 Fannin St Houston, TX 77030

Am J Dis Child. 1988;142(4):416. doi:10.1001/archpedi.1988.02150040066016

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In Reply.—Dr Cheng's kind comments about my editorial on innocent murmurs made me a "sitting duck" for the barb that was to follow ("... he forgot to point out. ") about my glaring omission of the location of Still's murmur!

Quite right, Dr Cheng; this murmur of aortic valve origin is heard best not in the so-called primary aortic area (second intercostal space at the right sternal edge) but rather in the secondary aortic area (third to fourth intercostal space at the left sternal edge). This of course makes sense when we think about it, since the aortic valve lies almost directly beneath the secondary aortic area (with the right ventricle intervening, of course). It is not the aortic valve but the ascending aorta that lies beneath the primary aortic area. Why, when, and by whom the second right intercostal space received the designation of primary aortic area, I do not

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