Diseases of the chest and the principles of physical diagnosis . Fig. 412.—Patent ductus arteriosus. Transposition of the aorta and the pulmonaryartery; patent ductus arteriosus; hypertrophy of the right ventricle. Patent foramenovale; artial atelectasis of the right lung; general visceral congestion. (.A. G. Ellis.) The murmur is usually loud, harsh, and of a churning or rasping in the case of imperforate ventricular septum the murmur is very longbeginning in systole and continuing into diastole. It may be loudest atits commencement and gradually diminish or it may gradually become
Diseases of the chest and the principles of physical diagnosis . Fig. 412.—Patent ductus arteriosus. Transposition of the aorta and the pulmonaryartery; patent ductus arteriosus; hypertrophy of the right ventricle. Patent foramenovale; artial atelectasis of the right lung; general visceral congestion. (.A. G. Ellis.) The murmur is usually loud, harsh, and of a churning or rasping in the case of imperforate ventricular septum the murmur is very longbeginning in systole and continuing into diastole. It may be loudest atits commencement and gradually diminish or it may gradually becomeintense at the middle period and then wane. In other instances the mur-mur may be double or while continuous may have a systolic and a dias-tolic accentuation. The second pulmonic sound is usually much accen- CONGENITAL HEART DISEASE 763. Descend-ing aorta Fig. 413.—Congenital aortic stenosis witb patency of the ductus arteriosus. Patho-logic Notes: The aorta is very small, measuring at the arch only cm. in diameter,while the pulmonary artery is twice this size. The innominate, left vertebral, and sub-clavian arteries are normal in position and size. Immediately at the junction of the loweredge of the left subclavin artery and the aorta, the latter vessel shows a sudden and markedconstriction, the external diameter of which measures 12 mm., while 3 cm. above and belowthe constriction the aorta measures 2 and cm. in diameter. On opening the aorta andlooking down toward the constriction the vessel appears to end in a smooth, rounded, blindpouch, but on closer inspection a pinhead-sized opening can be seen, through which a smallprobe can be passed. {Pennsylvania Hospital.) 764 DISEASES OF THE PERICARDIUM, HEART, AND AORTA tuated, a point which serves to distinguish the murmur from that causedby puhnonarj stenosi
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