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This is the aortic knuckle. In VSD Eisenmenger and PDA Eisenmenger, you would not expect right atrial enlargement. In VSD and PDA Eisenmenger, the heart size decreases when pulmonary hypertension develops, due to decrease in the shunt. It is not visible here. And you are seeing some end on views probably.
Diagrammatic representation of VSD Eisenmenger. The other Eisenmenger syndromes are not called Eisenmenger complex, only VSD Eisenmenger is called Eisenmenger complex. Large ASDs usually develop Eisenmenger syndrome, may be after decades, not like early development of Eisenmenger syndrome in VSD and PDA.
This is the aortic valve in closed position and mitral valve also appears to be closed in position. You can also see the aortic override. The VSD is partly overrided by the aorta. So, when there is an aortic override, if the override of the aorta is less than 50%, you think of tetralogy of Fallot.
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