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A31 year old woman presented with significant effort induced dyspnoea and was noted to have a heart murmur at birth which was not investigated. During childhood and adolescence she experienced slight effort related dyspnoea and experienced a single syncopal event in her 20s. Physical examination disclosed a mild parasternal right ventricular (RV) lift and grade 3, high pitched, continuous murmur best heard at the mid upper left sternal border radiating to the …