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Recording provided by Jules Constant, MD.

Split 2nd Heart Sound With Atrial Septal Defect
Sound is that of fixed S 2 splitting, ie, S 1 -A 2 -P 2 at rest (“out”) and with inspiration (“in”). Splitting is fixed because the volume of flow through the right ventricle is increased, eliminating the normal delay in closure of the pulmonic valve associated with inspiration.