You are incorrect - the most likely diagnosis in our patient is an isolated atrial septal defect.


Your choice: Atrial septal defect and pulmonary valve stenosis

Patients with an atrial septal defect and pulmonary valve stenosis typically present with findings that vary according to the severity of the pulmonary stenosis. A pulmonary ejection sound is usually present regardless of the severity of the stenosis. In patients with severe pulmonary stenosis, findings typically include a giant "a" wave in the jugular venous pulse, and a sustained right ventricular impulse. The auscultatory findings at the upper left sternal edge may include wide, splitting of the second heart sound with a soft P2 component and a systolic long, late peaking, crescendo-decrescendo murmur. A fourth heart sound that increases with inspiration may also be heard at the lower left sternal edge.