<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 12-year-old boy presents to the pediatrician for a routine checkup. He and his family immigrated from Pakistan to the United States when he was 9 years of age. Per his mother, he had measles when he was 4 years of age and a high fever following a sore throat at the age 7. He received all appropriate vaccinations when he arrived in the United States. He takes no medications. He does well academically and plays soccer in a recreational league. He was born at 38 weeks gestation. His temperature is 98.4F 36.9C, blood pressure is 11565 mmHg, pulse is 80min, and respirations are 18min. On exam, he is a healthy boy in no apparent distress. Breath sounds are equal bilaterally with good aeration. Fixed splitting of the second heart sound is noted on auscultation. Without adequate treatment, this patient will be at increased risk for developing which of the following?? A: Acute endocarditis, B: Extra-cardiac left-to-right shunting, C: Mitral regurgitation, D: Mitral stenosis, E: Reversal of left-to-right shunting,  <response>: This is a multi-choice question asking about the increased risk for a 12-year-old boy who has a fixed splitting of the second heart sound on exam. The key findings in the stem are:- 12-year-old boy - Routine pediatric checkup- History of measles at age 4 and high fever after sore throat at age 7- Received appropriate vaccinations when immigrated to US at age 9- No medications- Doing well academically and physically - Born at 38 weeks gestation - Vital signs are normal- Fixed splitting of S2 on cardiac examThe fixed splitting of S2 indicates a structural abnormality causing delayed pulmonic valve closure relative to aortic valve closure. This is most commonly seen with an atrial septal defect ASD or ventricular septal defect VSD, which causes increased pulmonic blood flow and delayed pulmonic valve closure.Therefore, the patient likely has an undiagnosed ASD or VSD since birth. Without treatment, this would lead to increased risk of a reversal of left-to-right shunting and development of Eisenmenger physiology.E: Reversal of left-to-right shunting 