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Diuretic-resistant pretricuspid shunt: what is the missing link?
  1. Daniel Camfield1,
  2. Rachel Iveson1,
  3. David Warriner1,2,3
  1. 1 Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, South Yorkshire, UK
  2. 2 Department of Adult Congenital Cardiology, Leeds General Infirmary, Leeds, West Yorkshire, UK
  3. 3 Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, South Yorkshire, UK
  1. Correspondence to Dr Daniel Camfield, Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster DN2 5LT, UK; d.camfield{at}

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Clinical introduction

A man in his 70s presented with dyspnoea and oedema. He had a background of chronic kidney disease stage III and atrial fibrillation (AF). The working diagnosis was heart failure (HF).

On admission to the local hospital, 12 lead ECG demonstrated rate controlled AF and transthoracic echocardiography (TTE) demonstrated preserved left ventricular (LV) function with a dilated right ventricle (RV). Cardiac MRI (cMR) demonstrated a sinus venosus atrial septal defect (ASD). Despite receiving intravenous furosemide and oral metolazone, his symptoms and weight remained unchanged. Due to a suspicion the pretricuspid shunt was the cause of his right HF, he was transferred to the regional Adult Congenital Heart Disease centre for closure of his …

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  • Contributors DC and RI conceived the presented idea and wrote the first draft, which was revised by DW. All authors discussed and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.