25th May 2025

A 21-year-old university student presents to the emergency department with worsening breathlessness requiring three pillows to sleep at night and bilateral leg swelling.

A 21-year-old university student presents to the emergency department with worsening breathlessness requiring three pillows to sleep at night and bilateral leg swelling. His admission observations are: temperature 37 degrees Celsius, respiratory rate 26 breaths per minute, saturation 82% on room air, heart rate 120 beats per minute and blood pressure 90/60 mmHg. Clinical examination reveals central cyanosis, clubbing and raised jugular venous pressure.  Auscultation reveals a soft, continuous crescendo-decrescendo murmur and a loud P2. His chest x-ray shows cardiomegaly with prominent vascular and interstitial lung markings. An urgent inpatient transthoracic echocardiogram is requested. Which of the following is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.