Images of Memorable Cases: Case 12 Routine chest radiograph of an asymptomatic 85-year-old woman whose medical history was unremarkable aside from eight uneventful pregnancies. 12. Atrial septal defect Secundum type, with left-to-right shunting (proven by transesophageal echocardiography). This is the most common congenital heart disease in adults, affecting women twice as often as men. Without surgical intervention, most of these patients die by age 60. A few, however, do live into their 90s.