Prominent left hilum in an adult with valvular pulmonic stenosis.
Timing of normal non-stenotic pulmonic valve. In pulmonic stenosis there would be premature opening.
Whereas echocardiography can show premature opening of the pulmonic valve, auscultation alone may demonstrate a delay in pulmonic valve closure. The delay correlates with stenosis severity. This is more reliable than a reduction in the intensity of the pulmonic component of the second heart sound.
The pulmonic ejection sound is unique. It decreases in intensity during inspiration - becoming louder during expiration.
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