Studies on innocent praecordial vibratory murmurs in children. 3. Follow-up study of children with an innocent praecordial vibratory murmur

C de Monchy, G M van der Hoeven, J E Beneken
1973 Heart  
A group of 40 children, originally examinedfor an innocent praecordial vibratory murmur were reinvestigated after a mean follow-up period of 6 9 years (range 3-2 to II 5). All were subjected to a non-invasive cardiological examination, comprised of anamnesis, physical examination, electrocardiogram, phonocardiogram with pulsation tracings, and x-ray examination of the chest. From simultaneous recording of the electrocardiogram, phonocardiogram, and carotid artery tracing in supine position at
more » ... upine position at rest, left ventricular ejection time and pre-ejection period were calculated. In one of the 40 subjects re-examined, suspicion was aroused concerning the existence of a cardiac malformation. At cardiac catheterization a minimal haemodynamic abnormality was found with a doubtful relation to the original praecordial murmur. A positive statistical correlation wasfound between pubertal development on disappearance of the murmur. Subjects in whom the murmur had disappeared and subjects in whom a grade 2 praecordial murmur was still present at follow-up were individually matched on the basis of body height with subjects from the group of 85 normal controls investigated previously. In both sets of twin groups left ventricular ejection time and pre-ejection period were compared to standard adult values. No difference in left ventricular ejection time and pre-ejection period was found between the groups of children in whom the murmur had disappeared and their matched controls. The children still presenting a grade 2 murmur at follow-up, however, had lower pre-ejection periodsfor equal heart rate than their matched normal controls without a murmur. This finding confirms the results of a former study on children with an innocent praecordial vibratory murmur (de Monchy, van der Hoeven, and Beneken, I973). The innocent praecordial vibratory murmur is found sistency of the original diagnosis and its possible only in children (Marienfeld et al., I962). Here it relation to subclinical forms of rheumatic heart constitutes the majority of innocent murmurs disease (Luisada, I955) or congenital heart disease (Paulin and Mannheimer, I957). Though Marien-(Nadas, I963). Finally, a previous study having feld proved its ultimate disappearance, no informademonstrated a significantly shorter pre-ejection tion has been published on the relation between period in children with an innocent praecordial puberty and the disappearance of the murmur. vibratory murmur, interest was aroused in measur-Therefore, a follow-up study was undertaken in ing systolic time intervals in subjects who had previorder to investigate this possible relation. A followously shown one but in whom the murmur had up investigation in a group of these children could disappeared. also throw some light on the question of the con-
doi:10.1136/hrt.35.7.685 fatcat:iwj4tifusbb3tfwqit3p7a5zbm