As a newborn this child had symptoms of heart failure found to be caused by Ebsteinþs anomaly. In this anomaly the septal cusp of the tricuspid valve is partially attached to the ventricular septum, i.e. the cusp is abnormally fixed and leaks. After the neonatal period symptoms of heart failure often alleviate. At the time of investigation this child was symptomless, the heart was compensated and the tricuspid regurgitation was moderate, flow gradient was 30 mmHg and pulmonary flow was 1.5 m/s. The blowing systolic murmur caused by tricuspid regurgitation resembles respiratory sounds. In addition, a gallop rhythm, i.e. a clear third heart sound typical of Ebsteinþs anomaly, is heard in the apex. The phonogram also shows clearly the typical split of both first and second heart sounds. On inspiration both the murmur (larger tricuspid regurgitation) and the third heart sound become louder as venous return and atrial filling increase. Age 0.7 years, height 71 cm, weight 8 kg. Area of auscultation: apex.