A 15 year old African immigrant is referred after a murmur was detected during a routine medical examination. He appears to be asymptomatic. His birth and medical histories are unremarkable. There is no history of rheumatic fever.
The ECG appears normal.
The X-Ray appears normal.
Echocardiography shows a small perimembranous VSD, with minimal left to right shunting. No other structural cardiac defects are present and pulmonary vascular pressures are normal. The pulmonary to systemic blood flow ratio is 1.1:1
The coronary angiogram shows a left dominant coronary vasculature and is otherwise normal.