Examination of the infant by the physician reveals a loud continuous machinery-like murmur that is best heard at the upper left after breastbone (sternum). The opening of the palm of the hand placed in this area may detect a vibratory sensation called a thrill. A typical finding is bounding peripheral pulses that can be felt at the wrist and the top (dorsum) of the feet (the dorsalis pedis artery).
B. Treatment
The presence of a patent ductus necessitates its closure, which can be done at low risk. Surgical ligation is simple, but the newer techniques using transcatheter closure appear promising. A patent ductus may coexist with other malformations such as coarctation of the aorta and valvular aortic stenosis, and these lesions must be excluded before simple ligation of the ductus. A patent ductus is a potential site of endocarditis and prophylactic antibiotics are required.
With an ASD, however, because the flow across this left-to-right shunt is small, endocarditis is extremely rare and antibiotic prophylaxis is usually not recommended. It is one of the few heart lesions in which a murmur is heard and deformities are present for which prophylaxis is not required.

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