Right ventricular outflow tract obstruction physical examination

Associate Editor-In-Chief: ; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu]

Physical examination

 * A systolic murmur is often heard in the neonate.
 * A small percentage of patients have Noonan's syndrome.
 * Small stature, retarded, triangle-faced shape, webbed neck, ptosis, hypertelorism, low set ears, and pectus.
 * Noonan syndrome is familial.


 * If the lesion is severe (>75 mm Hg) then there is a giant a wave secondary to the reduced compliance of the right ventricule.
 * There is a loud systolic ejection murmur loudest in the second left intercostal space which peaks in late systole.
 * In severe forms, the pulmonic component of the second heart sound may be missing.