To the Editor.—Allen et al almost seem to have appreciated the point we were trying to make about being cautious in the interpretation of echocardiograms in Ullrich-Noonan syndrome, although their letter suggests that they are making the point. Unfortunately, they get bogged down in speculation and critique based on insufficient information.
We are preparing a detailed manuscript on echocardiography in Ullrich-Noonan syndrome and have only alluded to this subject in the article in question. We have now accumulated echocardiographic data on approximately 20 patients with Ullrich-Noonan syndrome—some of whom were included in Table 2 of our article. However, three of eight patients presented in this table as having left ventricular disease had not yet had echocardiograms, but all had cardiac catheterization and angiocardiography. (Because our Ullrich-Noonan series has been accumulated over a decade in two centers, there are many patients who never will be reached by us for