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Frequent bouts of pneumonia in infancy suggested a sizable left-to-right shunt, a supposition supported by the large pulmonary arteries and pulmonary plethora noted on chest radiograph (Figure 2).
The patient reported here had normal left ventricular function, and heart failure was purely right sided, due to the large left-to-right shunt.
The pulmonary veins make an abnormal connection to the right atrium, with coronary sinus or systemic veins resulting physiologically in an extracardiac left-to-right shunt.
A left-to-right shunt is also more common among migraine-with-aura patients.
In her, the duct is large enough to allow a moderately large left-to-right shunt that over time has produced severe left atrial and left ventricular enlargement.