9th May 2025

A 34-year-old male with known congenital heart disease presents to his GP due to worsening shortness of breath on exercise.

A 34-year-old male with known congenital heart disease presents to his GP due to worsening shortness of breath on exercise. He also reports intermittent palpitations, noticing a blue tinge to his lips and digits and swelling of his lower limbs. He states that due to the covid-19 pandemic, he has unfortunately not had any follow-up with his cardiology team for several years. 

On examination, he is dyspnoeic at rest, has cyanosis to the lips, has a flushed facial appearance and has clubbing to the digits. He has peripheral oedema and a right ventricular heave on palpation. A loud second heart sound is noted, with a possible pansystolic murmur heard loudest at the lower left sternal border. 

The GP thinks he may have a rare condition known as Eisenmenger Syndrome and will need urgent treatment within a tertiary centre.

Given his clinical findings, which underlying congenital heart defect most likely caused his symptoms?

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