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Cyanosis in late teens
  1. S G Williams,
  2. D J Wright,
  3. U M Sivananthan
  1. Institute for Cardiovascular Research, Yorkshire Heart Centre, Jubilee Building, Leeds General Infirmary, Leeds LS1 3EX, UK
  1. Dr Williamssimongwilliams{at}

Statistics from

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.

Figure 1

Transoesophageal echocardiogram. Ao, aorta; LA, left atrium; MPA, main pulmonary artery; RPA, right pulmonary artery.


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.

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