**4.1.3 Clinical assessment of severity**

The timing of the click, the extent of splitting of the second sound, the intensity of the pulmonary component of the second sound, the length (duration) of the murmur, and timing of peaking of the systolic murmur are usually suggestive of the severity of pulmonary valve obstruction (Figure 2) (Rao 1991b, Vogelpoel & Schriere 1960).

The loudness of the ejection systolic murmur does not indicate the severity of obstruction but rather its duration and time of peaking; the longer the murmur and the later it peaks, the more severe is the PS. Similarly, the shorter the time interval between the first heart sound and ejection click, the wider the splitting of the second heart sound, and softer the pulmonary component, the more severe is the degree of pulmonary valve obstruction (Rao 2000).
