Continuous murmur due to the combination of rheumatic mitral stenosis and a rare type of anomalous pulmonary venous drainage.

SUMMARY A patient is described in whom a continuous murmur was caused by the combination of rheumatic mitral stenosis and a rare form of partial anomalous pulmonary venous drainage. In this case, the left superior pulmonary vein drained into the left atrium and also into a large anomalous vein which then drained to the right atrium via the innominate vein and superior vena cava. At surgery, mitral commissurotomy and then ligation of the anomalous vein were performed with a good result; the continuous murmur was no longer audible after operation. The embryology, physiology, auscultatory findings and surgical consideration are discussed. by the continuous flow of blood through a channel, across which a significant pressure gradient exists throughout the cardiac cycle. Patent ductus arteriosus is the best known example of this situation, and the flow is from the systemic to pulmonary circulation. Continuous murmurs may also be associated with arterial to venous shunts (e.g., rupture of aneurysm of sinus of Valsalva into the right atrium), coronary, pulmonary, or systemic arteriovenous fistulae, systemic or pulmonary arterial narrowing, and increased peripheral or collateral flow. Ross and associates1 have described a continuous murmur in patients with the combination of atrial septal defect and left atrial hypertension. The purpose of of anomalous vein this communication is to describe an additional cause of a continuous murmur in a patient with rheumatic mitral stenosis and a rare form of partial anomalous pulmonary venous drainage with an extrapericardial connection between the left and right atria. Report of Case C. B., a 28-year-old Caucasian male, was hospitalized at ages 13 and 23 with acute rheumatic fever. Nevertheless, he was well and active until 2 months prior to admission when he noted marked dyspnea on exertion, a persistent dry cough, and fatigue. Three weeks prior to admission, he was admitted to another hospital with tachyeardia and severe shortness of breath. He responded to treatment for congestive heart failure and was referred to Johns Hopkins Hospital for cardiac evaluation.