A 57 year old woman with a history of sinus venosusatrial septal defect and partial anomalous pulmonary venous return (PAPVR) repaired in childhood presented to the adult congenital heart disease clinic with junctional rhythm and significant lower extremity swelling. She had three surgeries during childhood for congenital heart disease. She did not have consistent care for her heart disease and her surgical history was not clear at presentation. In addition to her congenital heart disease she had known active hepatitis C infection. A month before presentation, she was evaluated for dizziness with bradycardia. She continued to have intermittent bouts of dizziness without syncope.