Abstract
A 46-year-old woman presented with progressive fatigue. Her past history was remarkable for partial atrio-ventricular septal defect repair at the age of 9 years. Physical examination was notable for obesity, positional desaturation (PaO2 = 92% standing vs. 88% supine) and Grade 2/6 apical pansystolic murmur. Transthoracic echocardiography showed an intact atrial septum and mild mitral regurgitation. Saline contrast injection from the left arm showed prompt filling of both atria with bubbles consistent with a significant extracardiac right-to-left shunt and suggesting communication at the caval level (see …
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