Echocardiographic images reveal a normal left ventricular ejection fraction (63%), over-riding of the aorta and a wide ventricular septal defect (VSD) with bidirectional shunting. The right ventricular systolic pressure is observed to be 120 mm Hg with right ventricular hypertrophy. Severe pulmonary stenosis is observed with a peak gradient of 97 mm Hg. VSD=ventricular septal defect.