Abstract
Presentation of Case First admission. A thirty-four-year-old woman entered the hospital because of vaginal bleeding.At the age of eighteen years she was referred to the Cardiac Clinic because of a chronic cough and dyspnea; the diagnosis of an interatrial septal defect was made. Two years before admission she returned to the hospital for right-sided cardiac catheterization, which showed a markedly increased pulmonary blood flow and a diagnosis of ostium primum defect was made. Four months before entry there was the onset of vaginal spotting, which became more severe three months later.Physical examination revealed a mildly cyanotic woman. The . . .
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