Auscultatory and Phonocardiographic Signs of Atrial Septal Defect

Atrial septal defect from persistence of the ostium secundum, or occasionally of the ostium primum, is one of the most common varieties of congenital heart disease. The clinical signs in previously published cases were evaluated by Roesler (1934), and clarified in a large personal series by Bedford et al. (1941). At that time the frequency of a systolic murmur was well recog- nized: it had been attributed by Roesler (1934) to associated mitral valve disease, and by Taussig et al. (1938) to interatrial flow. Diastolic murmurs were ascribed to mitral valve disease or to pulmonary incompetence. The pulmonary second sound was described as accentuated. The diagnosis rested mainly on the radiological findings first described by Assman (1929), and the electrocardiogram (Routier et al., 1940). Physical examination, except for the evidence of right heart involvement, was thought to offer little or no assistance in the diagnosis of atrial septal defect (Burrett and White, 1945). Cardiac catheterization enabled the diagnosis to be made at an earlier stage (Brannon et al., 1945) and the physical signs were re-examined by Barber et al. (1950), and by Wood (1950) who pointed out that the second sound was split and not accentuated in uncom- plicated atrial septal defect. They found a diastolic murmur at the left sternal edge in half their cases and attributed this to pulmonary incompetence. The development of the phonocardiograph has allowed a more accurate analysis of the heart sounds and murmurs in atrial septal defect. This shows that auscultation can be an important aid to the clinical diagnosis.