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A 36-year-old woman presented with chest pain, dyspnoea and fatigue. There was a grade 2/6 systolic murmur and long decrescendo grade 3/4 diastolic murmur at the right sternal border. Transthoracic echocardiography showed a defect connecting the aorta (non-coronary sinus of Valsalva) and right heart at the level of the tricuspid valve (upper panels). Right heart catheterisation demonstrated a …