Relation of Still's murmur, small aortic diameter and high aortic velocity

The origin of Still's innocent murmur, first described in 1909, is obscure. Seventy normal children and young adults, 29 with Still's murmur and 41 with no murmur, were studied. Pulsed Doppler and 2-dimensional echocardiography were used to evaluate possible causes, including tricuspid regurgitation, left ventricular bands, ascending and descending aortic and pulmonary velocities, ascending aortic diameter, and magnitude of spectral widths. Mean ascending aortic diameter relative to body surface area was significantly smaller for the group with Still's murmur (p less than 0.001). Since cardiac output was similar for the 2 groups, the average peak ascending velocity (133 cm/s) and average peak descending aortic velocity (118 cm/s) were significantly higher in the innocent murmur group as compared to similar respective means in the control group without the murmur (107 and 104 cm/s, respectively) (p less than 0.001 and p less than 0.01, respectively). No significant differences were found when the 2 groups were compared with respect to mean peak pulmonary artery velocity adjusted for body size, spectral widths in the ascending and descending aorta and in the pulmonary artery, and the presence of tricuspid regurgitation or ventricular bands. These observations suggest that the origin of Still's murmur is related to a small ascending aortic diameter with concomitant high aortic blood flow velocity.