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An isolated perimembranous ventricular septal defect (pmVSD), viewed from a right parasternal left ventricular outflow image, shows discrete bulging of the sinus of Valsalva (arrow) and the opened aortic valve cusp (arrowhead) into the defect. The double arrow shows the pmVSD longitudinal diameter. Ao, aorta; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle
