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The blood arrives back to the left atrium of the heart via the pulmonary veins.
There are likewise two pulmonary veins, entering the left atrium by one orifice.
Chronic coughing is a common presentation due to the large left atrium pressing on the airways.
This abnormal opening is called an atrial septal defect and causes blood from the left atrium to flow (or "shunt") across the hole into the right atrium.
If the defect is large, oxygen-rich blood from the left atrium flows back into the right atrium and gets pumped back to the lungs again, causing more work for the heart and lungs.