Auscultation in patent ductus arteriosus; with a description of two fistulae simulating patent ductus.

THE INVESTIGATION DESCRIBED A series of 73 patients with patent ductus is described, of whom 71 were selected for surgical treatment, while the two remaining patients had complicating severe pulmonary hypertension with a right-to-left shunt. The diagnosis of patent ductus was confirmed at operation in 71 patients. In the two patients with pulmonary hypertension, who were not treated by operation, necropsy proof of the diagnosis was obtained. In the nine-year period, during which these patients were operated upon, six other patients were submitted to thoracotomy, in whom the ductus was found to be closed. In four of these patients the diagnosis remains in doubt, although one patient is thought to have an aorto-pulmonary septal defect. The other two patients with fistulae have been further investigated and submitted to a second operation; in one it has been shown to be between the aorta and right ventricle and in the other between the coronary artery and right ventricle. Clinical examination was amplified by a phonocardiogram in every patient and in 20 a postoperative phonocardiogram was obtained. Routine examination before operation also included a teleradiogram and an electrocardiogram. Cardiac catheterization was performed in 12 patients in whom pulmonary hypertension, a large shunt, or associated heart disease indicated the need for fuller investigation. Angiocardiography was carried out in one patient, in whom coarctation and an aneurysm of the aorta were present in addition to a patent ductus.