<s>[INST] my sister age 17 years old diagnose with ASD since birth. now 4.4cm. she has been given electric shock 360 jule 2 times within 3 months and admitted to CCU. currently a doctor said she also suffered RBBB. please advise me the best option for her..thank you in advance. [/INST] Thanks for your question on Chat Doctor. I can understand your concern. BBB (right bundle branch block) in ASD patient is suggestive of worsening of heart disease. And ASD size of 4.4 cm is too large. Better to consult cardiac surgeon and discuss surgical repair of ASD. Surgery is the only option for her. She might need valvular replacement also. So consult cardiac surgeon as soon as possible and discuss all these. Don't wait at home. Hope I have solved your query. I will be happy to help you further. Wishing good health to your sister. Thanks </s>