23rd September 2021

A 16-year-old female presents to the emergency department with worsening breathlessness

A 16-year-old female presents to the emergency department with worsening breathlessness and reduced exercise tolerance over the past year. However, she reports no chest pain or cough. She has no past medical or family history. On examination, she has a short systolic murmur. However, there are no other significant findings. She is admitted to hospital, and an echocardiogram is performed, which shows a right-to-left interatrial shunt. Pulmonary vasodilator testing is carried out, but the shunt remains irreversible.

Which of the following is the most appropriate management?

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