Phonocardiographic features of the systolic murmur in pulmonary artery stenosis

these reports it appears that the clinical recognition of the anomaly is difficult except in the presence of a continuous murmur radiating widely to one or both axillae and the back. In the majority of the reported cases, however, a basal systolic murmur was observed; this, too, often showed a wide lateral propagation suggestive of the diagnosis. In a case of pulmonary artery stenosis recently observed in this department it was noted that the basal systolic murmur had characteristic timing and configuration. We think that these features are present in most, if not all, cases of pulmonary artery stenosis with a systolic murmur, and their recognition should provide additional help in the clinical diagnosis of the lesion. HEMODYNAMIC FEATURES The 26-year-old woman presented with clinical, electrocardiographic, and radiological features suggestive of atrial septal defect. Right heart catheterization substantiated the clinical impression by demonstrating left-to-right shunt at atrial level with pulmonary to systemic flow ratio of 3 to 1. In addition a systolic gradient of 12 mm. Hg was found between the right and main pulmonary artery (Fig. 1 A and B). By rapid withdrawal of the catheter (Fig. IC) a gradient across the pulmonary valve was simulated, presumably as a result of failure to record beats from the main pulmonary artery proximal to the stenosis. Cine-angiocardiography demonstrated narrowing at the origin of the right pulmonary artery (Fig. 2). This served to confirm the diagnosis which might otherwise be questioned in view of the occasional occurrence of functional gradients in branches of the pul-monary artery with high pulmonary flow (D'Cruz et al., 1964; Delaney and Nadas, 1964)