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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.

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