Аудіо 00060. Large perimembranous VSD and aortic regurgitation

This child has been followed up for perimembranous VSD. Pulmonary circulation pressure is normal. The child has been rather healthy and evaluation of the need for surgery was set at the age of three years. Since the previous follow-up visit a year ago, the heart has grown and now a diastolic murmur is also heard. The child is more tired that earlier, but has not heart failure. On auscultation a fifth-degree systolic and a third-degree diastolic murmur are heard. Echocardiography shows a 7-mm VSD with a 96-mmHg gradient as estimated from flow velocity, i.e. pulmonary circulation pressure continues to be normal, but fairly large aortic valve regurgitation has developed. This child is referred for surgery. Phonogram shows an aortic regurgitation sound that extends throughout the entire diastole. Spectrogram contains several high-frequency configurations in the VSD flow that match rapid flow and thus normal right side pressure. Age 3.0 years, Area of auscultation left third ic (LIC3).