Clinical History.—This 9-year-old girl was admitted to St Barnabas Medical Center on July 20, 1973, for cardiovascular studies. She was referred because of a heart murmur, easy fatigability, and shortness of breath on exertion. Her past history was as follows: birth weight was 3.5 kg; she was cyanotic at birth (which cleared quickly), and she had a cleft palate that was surgically repaired. She had not had heart failure in the past.
Physical Examination.—Her weight was at the third percentile and her height was at the tenth percentile. She was acyanotic and there was no clubbing of the fingernails. She had webbing of the neck, cleft palate, and Sprengel deformity of the left shoulder. The breath sounds were diminished in the left side of the chest and resonant in the right side of the chest. The point of maximal impulse was at the fifth left intercostal space, 3