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An 18 year old youth presented with a three year history of decreasing exercise tolerance and cyanosis. Physical examination revealed clubbing and cyanosis, with an estimated oxygen saturation of 76% (on air). There were no other abnormalities on cardiovascular or respiratory examination. Arterial blood gas estimation revealed a Po 2 of 5.85 kPa breathing air, increasing only to 6.8 kPa after 10 minutes on 100% oxygen. Haemoglobin was 22 g/dl. ECG, chest x ray, and conventional echocardiography were normal.
A transoesophageal echocardiogram is shown in fig1.
- What is the most likely cause of the cyanosis?
- What does the transoesophageal echocardiogram show?
- What treatment options are available for this patient?
Answers on p 56.