Echocardiographic correlate of presystolic pulmonary ejection sound in congenital valvular pulmonic stenosis.

A presystolic ejection click was present in a patient with congenital valvular pulmonic stenosis. The coincidence of this sound with presystolic pulmonary valve opening was demonstrated by simultaneous phonoechocardiography. Hemodynamic confirmation of this observation was made by demonstrating presystolic crossover of RV-PA pressures. This sound was distinguished on phonocardiogram as a high frequency sound separate from a lower frequency presystolic (S4) gallop.