Noonan syndrome with multiple lentigines (NSML), which is also known as LEOPARD syndrome, has the cardiac manifestation of pulmonary valve stenosis and hypertrophic cardiomyopathy along with brown spots on the skin called lentigines, caused by the mutation in one of four genes: BRAF, MAP2K1, PTPN11, and RAF1 (12–14). This evidence concerns the gene RAF1 and pulmonary valve stenosis.