Hypoplastic right heart complex in a 46-year-old woman.

The patient had been cyanotic since birth. She was first evaluated at Duke University Medical Center when she was 20 years old at which time her heart was slightly enlarged but no murmurs were heard. At the age of 24 she developed pelvic thrombophlebitis which resulted in paradoxical emboli and an acute diaphragmatic myocardial infarction. Shortly thereafter she began to have occasional chest pain, but she did not require cardiac medication. Deterioration of cardiac function, in fact, did not begin until six months before death when the chest pain became more frequent and signs of congestive heart failure appeared. A phonocardiogram one month before death disclosed an apical systolic murmur, a widely split second heart sound which moved slightly with respiration, and an early pulmonary ejection murmur. Three weeks later the patient was admitted to hospital with congestive heart failure. Her blood