The ejection sound, caused by the impact of left ventricular outflow against the partially fused aortic valve leaflets, is more commonly associated with a mobile bicuspid aortic valve than an immobile calcified aortic valve.
2.
The first heart sound may be followed by a sharp ejection sound ( " ejection click " ) best heard at the lower left sternal border and the apex, and, thus, appear to be " split ".
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