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January 1961

Preoperative Evaluation of a Continuous Murmur in the Chest

Author Affiliations

Research Fellows, National Heart Institute, National Institutes of Health, U.S. Public Health Service (Dr. Sleeper, Dr. Thompson).

Arch Surg. 1961;82(1):74-87. doi:10.1001/archsurg.1961.01300070078011

Correct preoperative diagnosis is one of the prime requisites of successful cardiovascular surgery. The diagnosis should be made with a minimum of cost, time-consuming diagnostic studies, and discomfort to the patient. Often simple techniques such as careful auscultation and phonocardiography will reveal characteristics of associated murmurs which in themselves may be diagnostic. An example is the classical murmur of a patent ductus arteriosus. This murmur is best heard in the first and second left intercostal spaces. It begins a short interval after the first sound, usually reaches maximal intensity in late systole, envelops the second sound, and continues well into diastole. The murmur is therefore classified as a continuous murmur. When the characteristic murmur is present and if the clinical findings are corroborative, extensive diagnostic studies may not be indicated. However, many patients with patent ductus do not exhibit such a typical murmur. Other cardiovascular defects may produce continuous murmurs