Doppler study of precordial musical murmurs.
Using phonocardiography, continuous- and pulsed-wave Doppler, 51 patients with precordial "musical" murmurs (49 with cardiac abnormalities) and 21 patients with noisy murmurs were examined. With M-mode echocardiography, fine fluttering of the structure generating the murmur was evident in 23 patients with musical murmurs and in 5 with noisy murmurs. A continuous-wave Doppler spectral signal characterized by parallel harmonics (Doppler musical signal) was evident in all patients with musical murmurs and in none with a noisy murmur. With pulsed-wave Doppler, the musical signal had less defined spectral features because of range ambiguity. Such a signal was experimentally reproduced by activating a diapason bathed in saline solution. The source of the musical murmur was established in all 51 patients by Doppler. The musical signal was associated with a valvular regurgitation signal in 36 patients and with a ventricular septal defect in 1 patient. The musical signal always disappeared when the pulsed-wave Doppler sample volume was placed 2 cm away from the generating structure. In 11 patients with musical murmur examined by color Doppler, no abnormal bidirectional flow signal was observed in the structures generating the signal. In 6 of the patients without valvular regurgitation, no flow disturbance was found. In conclusion, Doppler is valuable in determining the source of musical murmurs, and musical murmurs are caused by a vibrating structure even in the absence of flow turbulence.
Pennestri
F
F
Department of Cardiology, Catholic University, Sacro Cuore, Rome, Italy.
Boccardi
L
L
Minardi
G
G
Di Segni
M
M
Pucci
E
E
Biasucci
L M
LM
Ferrari
O
O
Lombardo
A
A
Giovannini
E
E
Loperfido
F
F
D001022:Aortic Valve Insufficiency / Q000175:diagnosis; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D006326:Heart Auscultation; D006337:Heart Murmurs; D006349:Heart Valve Diseases / Q000175:diagnosis*; D006350:Heart Valve Prosthesis; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000175:diagnosis; D009200:Myocardial Contraction; D010701:Phonocardiography