The diagnoses are: valvular pulmonary stenosis, Noonan,s syndrome, bronchial asthma. Balloon valvoplasty was performed on this child at the age of 18 months for tight pulmonary stenosis. The valve continues to be stenotic, and the degree of stenosis has remained constant during the past two years and there is no significant regurgitation. The flow gradient in the pulmonary artery is 51 mmHg. In the phonogram heart sounds are covered by the murmur and respiratory sounds are heard even louder than the murmur. Spectrogram shows many high frequencies that match moderate stenosis. The pressure gradient derived from flow velocity exaggerates the true gradient, particularly with high flow velocities. These findings do not warrant new interventions. On auscultation a fourth-degree pansystolic murmur is heard in the left second and third intercostal spaces and P2 is not distinguished. Respiratory sound is loud and bronchial and masks the cardiac murmur. No significant regurgitation, the gradient has not changed. This child also has asthma. Note breathing on this recording. Age 4.2 years, height 100.0 cm, weight 16.0 kg. Area of auscultation left second ic (LIC2).