A 27-year-old man presented to our department with palpitations; he had no other cardiac symptoms and his medical record was unremarkable. Physical examination was normal except for a 3/6 systolic murmur at the left sternal border. Transthoracic echocardiography showed an echo-free tunnel-shaped space (14 × 20 mm) from the LV to the RA ( Fig. 1 ), in which blood flow travelled forward in systole ( Fig. 2 ). White blood cell count and haemoglobin and electrolyte concentrations were normal; no elevated cardiac enzymes were found. A chest X-ray showed no abnormalities. An electrocardiogram showed normal sinus rhythm. There were no signs of endocarditis on transthoracic echocardiography. The patient underwent surgical neoplasty successfully using cardiopulmonary bypass. During surgery, a communication defect was found between the LV and the RA, below the right coronary cusp.
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