A 20 year old girl presents with exertional dyspnea and palpitations for 5 months. There is no history of a cough, chest pain, orthopnea or paroxysmal nocturnal dyspnea. Her medical and family histories are unremarkable.
The ECG reveals P-pulmonale, right axis deviation, and a right bundle branch block.
There is mild enlargement of the right side of the cardiac silhouette.
An osteum secondum atrial septal defect 1 cm in diameter is noted, with a left to right shunt. The ratio of pulmonary to systemic flow is approximately 1:1.6. The right atrium and ventricle are moderately dilated.
Coronary Angiography demonstrates a normal coronary vasculature.