Perimembranous mild-to-moderate VSD near the aortic valve, but without aortic regurgitation. ECG and chest radiograph are normal. The size of the shunt was such that the benefits of surgery were not obvious. The child has been followed up for a few years and a new evaluation is now being made. On echocardiography the flow through the VSD is 5 m/s, through the aorta 0.9 m/s and through the pulmonary artery 1.3 m/s. On auscultation a fourth-degree pansystolic murmur is heard in the precordium. The phonogram shows a pansystolic, rather even murmur, and the spectrogram shows high frequencies suggesting high flow velocity. As the heart contracts the size of the shunt is reduced causing increased flow velocity and thus also increased frequencies towards endsystole. Age 6.1 years. Area of auscultation: left third ic (LIC3).