Echocardiogram and phonocardiogram related to the movement of the pulmonary valve

Pulmonary valve movement and the related acoustic phenomena were investigated using high speed strip-chart echo- and phonocardiographic recording. The opening of the pulmonary valve had no definite relationship to the acoustic phenomena, whereas the pulmonary ejection sound was closely related in time to the early systolic maximal opening of the valve. The concomitant pulmonary ejection systolic murmur faded away by the time of the mid-systolic semi-closure of the valve, where the tiny extrasound occurred in a half of cases. The pulmonary component of the second heart sound occurred after the valve closure, and the time lag maximally reached up to 50 msec. Pulmonary hypertension tended to minimize this delay, giving the so-called single loud second heart sound. Graham Steell murmur started with the pulmonary component of the second heart sound and reached up to the isometric contaction phase beyond the first heart sound.