This is a four-year-old girl who has already had surgery on her aortic valve because of stenosis. The first part of the video is immediately before her aortic valve was replaced because of aortic incompetence. The diastolic murmur due to the incompetence is best heard at the mid and lower left sternal border. The ejections systolic murmur of aortic stenosis is best heard at the upper right sternal border. Postoperatively the mechanical heart sounds are obvious.

This premature baby has a patent ductus arteriosus murmur. This is a 12-day-old twin born at 29 weeks’ gestation. The girl is being fed nasogastrically and is tachypnoeic with a respiratory rate of 86 breaths per minute. On auscultation, she has a clearly heard systolic murmur that is only just audible into diastole.

This is a four-month-old infant with a complete atrioventricular septal defect who is in heart failure. Clinical features of respiratory distress secondary to heart failure are shown. These include tachypnoea, intercostal and subcostal recession, nasal flaring, head bobbing and suprasternal recession. Auscultation at the apex reveals a pan-systolic murmur of atrioventricular incompetence, whereas auscultation at the upper left sternal border reveals a more ejection-type systolic murmur due to the increased pulmonary blood flow and a loud pulmonary component to the second heart sound due to pulmonary hypertension.

This is an animation of tricuspid atresia and a Fontan circulation. All systemic venous return goes directly into the pulmonary artery and the single left ventricle pumps the blood around the body.