Innocent Murmur

• Also known as Still’s murmur
• Etiology/Risk Factors
  • Benign finding in ~30% of children ages two to seven years
• Pathophysiology
  • High‐pitched, vibratory, short systolic murmur heard at left mid‐sternal border
  • Frequently silent in supine position
  • Turbulent blood flow
    • Fever
    • Anemia
    • Rapid growth
• Treatment
  • Generally none indicated
  • Evaluation for true valvular dysfunction
• Primary Concerns
  • Distinguishing from other murmurs
• Evaluation
  • Auscultation
  • History
    • Exercise tolerance
    • Chest pain
  • Consider cardiologist consult
    • ECG
    • Echo
• Anesthesia Management
  • Patients are generally asymptomatic with no special perioperative concerns

Patent Ductus Arteriosus (PDA)

• Etiology/Risk Factors
  • Premature birth [14]
  • Chromosomal abnormalities
• Pathophysiology
  • In fetal circulation, the ductus arteriosus allows blood to flow from the pulmonary artery to the aorta, bypassing the nonfunctioning lungs
  • Typically closes soon after birth in response to:
    • ↑ PaO₂
    • ↓ PGE2
  • Small lesions are asymptomatic, while large lesions may lead to significant left‐to‐right shunting, cardiomegaly, and CHF (Figure 7.12)
  • Continuous “mechanical” murmur (much like a Russian submarine) heard at midclavicular line between first and second interspace

• Treatment
  • Spontaneous closure beyond infancy is rare
  • COX inhibitor
  • Surgical or catheter closure
• Primary Concerns
  • Risk for infective endocarditis low
• Evaluation
  • Auscultation
  • Review past records for documentation of normal function
  • Cardiology consult
• Anesthesia Management
  • Antibiotic prophylaxis generally NOT necessary unless there is other associated unrepaired cyanotic heart disease, recent device closure, or device closure with residual adjacent defect
  • Post closure, patients are generally asymptomatic with no special perioperative concerns