Murmurs heard over the back in children with heart disease are usually thou
ght to be caused by pulmonary stenosis and coarctation of the aorta. In thi
s prospective study 59.6% of 104 children with various congenital and acqui
red heart defects were found to have an audible murmur over the back.
An audible murmur over the back of a child with a ventricular septal defect
was indicative of either a very small ventricular septal defect or an acco
mpanying underlying cardiac lesion. In children with ventricular septal def
ect and/or mitral incompetence, auscultation over the back contributed towa
rds making a more accurate clinical and/or anatomical diagnosis. A child wi
th mitral incompetence and an audible murmur over the back will have a grad
e 2 or more echocardiographic evaluated valve lesion. It is concluded that
the presence of a murmur over the back rarely contributes to the final diag
nosis but may be indicative of the severity of the underlying lesion.