68 year old lady with atrial septal defect and shortness of breath
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Left to right shunts such as atrial septal defect, ventricular septal defect and patent ductus arteriosus, cause increased pulmonary blood flow. With time, high pulmonary vascular resistance will develop, ultimately causing right to left shunt.
Chest xray show dilation of central pulmonary arteries and pruning of peripheral pulmonary arteries, right ventricular and atrial enlargement. Left heart would return to normal size.