Figure 5. (A–C) The right-left heart catheterization in our patient demonstrated a high right ventricular systolic pressure of 120 mmHg compared with a left ventricular systolic pressure of 128 mmHg. The systolic pressure gradient across the right ventricle to the pulmonary artery (120 to 106 mmHg), the main pulmonary artery (106 mmHg) to both the proximal right pulmonary artery (25 mmHg) and the left pulmonary artery (73 mmHg) were also reported. These findings were compatible with significant right ventricular outflow tract obstruction and significant peripheral pulmonary stenosis. Another finding was significant oxygen step-up from right atrium to right ventricular level (63% to 71%, respectively). Therefore, either an intracardiac shunt at the ventricular level or VSD patch leakage with a left-to-right shunt was confirmed in our case.