28-year-old female visite...

A 28-year-old female with no cardiac history visited the clinic for cardiac screening. She was a sport instructress, and her brother was recently diagnosed with a bicuspid aortic valve. Her height and weight were 173 cm and 68 kg. Her HR and BP was 60 beats/min and 110/60 mmHg. She had no symptoms and an excellent exercise capacity. 

The ECG and chest X-ray showed no abnormalities. On cardiac screening, First and second heart sounds were normal with a continuous murmur grade 2/6 left sub clavicular was heard. During the echocardiographic examination, a small shunt from the proximal descending aorta to the main pulmonary artery was seen, as shown in the figure. There were no signs of left ventricle volume overload and increased pulmonary artery pressure. In addition, there was no evidence of calcification of the ductus.