Clinical History.—This 14-year-old boy was admitted to the hospital for cardiologic evaluation because a systolic murmur had been detected during a routine school examination. He was asymptomatic. History disclosed that he had had a surgical procedure for pectus excavatum four years earlier. The thoracotomy scar was well healed.
Physical Examination.—Significant physical findings were limited to the heart. There was a loud systolic murmur along the left sternal border with the maximum intensity in the third and fourth interspace. There was no thrill. The pulmonary second sound was slightly accentuated. Roentgenograms of the chest were obtained (Fig 1 and 2).