The patient is a 26-year-old woman who has had weakness and malaise for 1 to 2 months. She has a past history of congenital heart disease, and she had ventricular septal defect (VSD) repair and repair of aortic valve prolapse 8 years ago. See Videos 5-1 to 5-5 and Figures 5-1, 5-2, 5-3, 5-4 and 5-5.