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The clinical data of 38 patients in whom an added sound at the beginning of the ejection phase was demonstrated in the phonocardiogram, are reviewed and compared with the x-ray picture, the electrocardiogram and in 7 cases with hemodynamic studies. In 28 of these patients, the systolic click was more intense at the apex or at the aortic area, while in the other 10 cases, it was more easily detected at the pulmonary area. In the first group we found 13 patients with aortic insufficiency, 2 with aortic stenosis, 8 with arterial hypertension, 3 with marked aortic atherosclerosis, 1 cases of coartation of the aorta an 1 patient with aortic dilatation of unknown origin. The second group was composed by 4 cases of mitral stenosis, 3 patients with chronic cor pulmonale, 1 with subacute cor pulmonale, 1 case of valvular pulmonary stenosis and 1 case of Eisenmenger's Syndrome with persistence of the ductus arteriosus. A feature common to all cases was the finding of marked dilatation of the aorta or the pulmonary artery. The problems in differential diagnosis with the splitting of the first heart sound and with the auricular sound are analyzed and the possible pathogenic mechanisms discussed, emphasizing the role of the dilation of the main vessels during ventricular ejection.