Fixed…Or Needs Fixing?

An asymptomatic 29-year-old female was referred for evaluation of a cardiac murmur. A preappointment electrocardiogram revealed right axis deviation, right bundle-branch block, and “crochetage sign” with notched R waves in the inferior leads (Figure 1A, arrows). Physical examination revealed normal jugular venous examination and a 2+ parasternal lift. Cardiac auscultation at the left upper sternal border (Figure 1B, phonocardiogram; Audio file in the Data Supplement) revealed normal S1, grade 2/6 early-peaking systolic ejection murmur, and fixed splitting of the second heart sound (A2-P2). Chest radiography (Figure 1C) showed enlarged right heart border …