This baby has a permembranous large VSD. Pulmonary blood pressure is elevated, and thus the left-to-right shunt is small. Regurgitation through the tricuspic valve resembles physiological flow. When this flow is used to evaluate the pressure difference between the right ventricle and atrium the result is 60 mmHg, which supports pulmonary hypertension. The murmur is short and at the most second-degree in severity and is explained by minor shunt. P2 is prominent and superimposed on A2. This finding is also seen on the phono- and spectrograms and matches pulmonary hypertension. The child makes voices throughout the recording. Age 0.1 years, weight 3.0 kg. Area or auscultation: left third ic (LIC3).