Ventricular septal defect
Shortness of breath.
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Cardiomegaly with prominence of the main pulmonary trunk. Dilated central pulmonary arteries with peripheral pruning. Paediatric type sternotomy wires with the most inferior one fractured.
This patient has a history of a ventricular septal defect, which when untreated can result in pulmonary arterial hypertension and cardiomegaly. Given the patient's symptoms, consideration can be given to Eisenmenger syndrome, where there is reversal of the left-to-right shunt and cyanosis develops (but this is not proven in this patient).