Abstract
Pulmonary stenosis is a congenital defect, with isolated severe cases rarely associated with cyanosis. We report a 10-year-old girl diagnosed with severe pulmonary stenosis (peak gradient 111 mmHg), presented with worsening cyanosis, chest discomfort, and exercise intolerance. We were perplexed by the presence of cyanosis in her current condition. The answer emerged during a right heart catheterization, revealing a previously undetected patent foramen ovale with eluded identification through a non-invasive trans-thoracic echocardiography.
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