- What is the abnormality seen here in image 6.1 and what is the natural history?
This is a bicuspid aortic valve. About 1% of all persons have such a valve. It typically does not lead to symptoms of aortic stenosis from progressive calcification until middle age. Auscultatory findings include a holosystolic murmur (from stenosis) along with holodiastolic murmur (from regurgitation).
- Name the lesion seen here in image 6.2. What is its natural history? Describe the auscultatory findings.
A large ventricular septal defect is seen. About half of these will become much smaller or close over time, but there can be a significant left to right shunt with large ones, and it can predispose to infective endocarditis. A left-to-right shunt would produce a holosystolic murmur. The intensity would be loudest when the VSD was small (large turbulence).
- What is this lesion in image 6.3? What physical exam findings could clue you in to its presence?
This is a post-ductal coarctation of the aorta. Much weaker pulses in lower extremities as opposed to upper extremities occurs because of the narrowed aortic lumen at this site. The major auscultatory finding would be a holosystolic murmur.
