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Patients with severe stenosis and right heart failure may have an unusually soft murmur because of low cardiac output. In mild stenosis, the murmur is relatively short and peaks at or before midsystole Fig. In moderate stenosis, the murmur ends at or slightly after the aortic component of the second heart sound, which remains audible. With severe obstruction, the murmur extends beyond the aortic closure sound, which may become inaudible.

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