Figure 5

Pulmonary stenosis in a 9-year-old. Haemodynamically insignificant pulmonary stenosis, with a 17–22 mmHg flow gradient on echocardiography. On auscultation a second-degree coarse, low-frequency systolic ejection murmur was heard. The phonogram shows the diamond shape compatible with stenotic murmur. Flow velocity is highest at the beginning of systole, and the peak frequencies also occur in early systole, with a descending frequency contour. The findings resemble ASD, the main difference being that P2 is quieter than normal. Because the stenosis is mild, however, P2 can be heard. Area of auscultation: left second ic space (LIC2). Duration 90%, peak frequency 264 Hz, volume 52 %.