Symptoms:

Small to moderate sized defects may produce no symptoms, or not until middle age or later. Symptoms that may occur can include:

• Difficulty breathing (dyspnea)
• Frequent respiratory infections in children
• Sensation of feeling the heart beat (palpitations) in adults
• Shortness of breath with activity

Signs and tests:

The doctor may hear abnormal heart sounds when listening to the chest with a stethoscope. A murmur may be heard only in certain body positions, and sometimes a murmur may not be heard at all. The physical exam may also reveal signs of heart failure in some adults.

If the shunt is large, increased blood flow across the tricuspid valve may create an additional murmur when the heart relaxes between beats.

Tests that may done include:

• Cardiac catheterization
• Chest x-ray
• Coronary angiography (for patients over 35 years old)
• Doppler study of the heart
• ECG
• Echocardiography
• Heart MRI
• Transesophageal echocardiography (TEE)