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This recording taken from a patient with secundum atrial septal defect with normal pulmonary artery pressures. Note: this recording from the 2nd left interspace shows the ejection systolic murmur due to the increased flow through the pulmonary outflow tract. The murmur ends with a pause. Following the pause one can clearly hear a wide split S2. The separation between the two components remains about the same throughout however. This is highly suggestive of a relatively fixed split S2 very characteristic of atrial septal defect.
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