Figure 1: Ultrasound images A) apical four cavity 2D echocardiography image showing dilatation of right ventricular with RV / LV higher than 0.6 in diameter and surface , atrial septal defect with 3 cm type ostium secundum; B) apical four cavity with color Doppler showing a left - right shunt; C) the subcostal window with color Doppler showing the atrial septal defect with shunt; D) apical four cavity centred on the right ventricle showing the expansion of the ring tricuspid to 5 cm. (LA: left atrium, LV: left ventricle, RV: right ventricle, RA: right atrium, Red arrow: atrial septal defect)