The VSD murmur is classically a holosystolic murmur similar to mitral regurgitation but located along the lower left sternal border, often with a palpable thrill. Flow is left to right (as pressure is higher on the left) but over time this can lead to pulmonary hypertension and reversal of flow, called Eisenmenger’s syndrome. We have observed a “reverse Carvallo’s sign” phenomenon, whereby the intensity of the murmur lessens during inspiration. We have reasoned that this occurs because the left –> right pressure gradient lessens during inspiration as a result of increased RV blood flow.

Ventricular Septal Defect

Annotated

Ventricular Septal Defect

Annotated