Which of the following findings is associated with large atrial septal defect (ASD)?

In the context of a large atrial septal defect (ASD), it is important to understand the physiological consequences of this condition. An ASD allows for shunting of blood between the left atrium and right atrium, leading to increased blood flow to the right atrium, right ventricle, and pulmonary circulation.

Frequent respiratory infections can be associated with a large ASD primarily due to the increased pulmonary blood flow. This elevated blood flow can lead to pulmonary congestion and increased risk for pulmonary complications, including infections. Children with large ASDs may experience respiratory symptoms and are predisposed to episodes of pneumonia or bronchitis due to the altered dynamics in their pulmonary circulation.

While asymptomatic presentation may sometimes occur, particularly with smaller defects, a large ASD typically leads to noticeable physiological changes, which makes frequent respiratory infections a more likely outcome. Similarly, normal pulmonary vascular markings would not be expected in the context of significant left-to-right shunting, as the increased blood flow often causes changes in the vascular markings on imaging studies. Lastly, a large ASD generally does not decrease left ventricular volume; it often leads to left ventricular overload due to increased blood flow returning from the lungs.

Thus, the presence of frequent respiratory infections is a key clinical finding associated with large