Clinical introduction A 28-year-old woman with a history of critical pulmonic stenosis, status postsurgical valvotomy and subsequent pulmonary valve replacement, presented to the cardiology clinic with 1 year of progressive exertional dyspnoea. She has a heart rate of 75 bpm and blood pressure of 110/55 mm Hg. Cardiac auscultation reveals a 1/6 systolic ejection murmur along the left sternum and an early 3/6 diastolic decrescendo murmur. A transthoracic echocardiogram is obtained (figure 1).

Questions Which of the following would be most likely found during right heart catheterisation?

1. Ratio of pulmonary to systemic blood flow (Qp:Qs) >1.5

2. Pulmonary vascular resistance >3 Wood units

3. Right atrial pressure >10mm Hg

4. Pulmonary artery systolic pressure >45mm Hg E. Pulmonary artery diastolic pressure <10mm Hg

Questions