About Video

This video contain simultaneous recording of echo image and phono recordings. Since the phono was made at the same time as the ultrasound was being recorded, there is some background noise which could not be eliminated. Please adjust the audio volume for comfort while listening to these files. The Echo image is taken at the level of the aortic valve. The aorta is at the center. To the left (anatomic) and anterior to the aorta is the pulmonary outflow tract. The pulmonary valve is seen to open and close. In the simultaneous audio recording from the phono microphone placed about the lower left sternal border, one can hear a clicking S1, which in this patient happens to be the pulmonary ejection click. Note that the pulmonary valve is seen well when it is in the closed position. If one follows the opening movement it reaches its peak at the time of the clicking S1. Thus the pulmonary ejection click times with the opening doming movement of the pulmonary valve in the echo image. Please note that the vibration of the ultrasound probe over the chest wall causes noise, which distorts the audio recording of the phono since the latter is done simultaneously. This random noise is in the background. This can be observed in this and other simultaneous echo and phono recordings. The second heart sound: The S2 is a sharper and crisper sound related to events associated with the closure of the aortic and the pulmonary valves at the end of the ejection phase of systole. In normal young adults one can usually recognize two components of the S2 namely the aortic (A2) and the pulmonary (P2). Since normally the left ventricular events are faster than that of the right ventricle and the impedance in the aorta (the systemic circuit) is greater than in the pulmonary artery (the pulmonary circuit), the A2 usually occurs before the P2. The A2 is heard over the true aortic area (the Sash area extending from the 2nd right interspace to the apex) where all aortic events are normally heard. The P2 is normally heard over the 2nd and 3rd intercostal spaces at the left sternal border. When the right ventricle is enlarged as in atrial septal defect or when there is pulmonary hypertension, the P2 may be heard over a wider area of the precordium including the apex. Inspiration brings more blood to the right side and tends to drop the impedance in the pulmonary circuit. This tends to delay the P2. On the left side however, during inspiration there is less volume in the left ventricle due to expansion of the lungs. This will tend to make the A2 come slightly earlier. Thus on inspiration, the A2 and the P2 tend to move away from each other. The reverse will occur on expiration.