A middle aged lady was diagnosed to incidentally have a ejection systolic murmur at the pulmonary area. A fixed wide split of the second heart sound was also noted. The diagnosis is:-
Classically presents as an asymptomatic patient with a ﬂow murmur in the pulmonary area and a ﬁxed  wide split of S2.
Atrial septal defects occur most commonly in the region of the fossa ovalis, referred to as secundum-type defects .Additional atrial  septal  defects  include  defects  of  the  sinus  venosus  and  atrium primum. Color flow Doppler echocardiography is usually sufficient for diagnosis of a secundum-type atrial septal defect, but agitated saline is generally needed for the diagnosis of other types of atrial septal defects.
Tetralogy of Fallot
Atrial septal defect
Mitral stenosis
Mitral valve prolapse