A 4-year-old girl from Mumbai presents with a systolic ejection murmur at the left upper sternal border and mild dyspnea on exertion. Chest X-ray shows cardiomegaly and pulmonary congestion. Echocardiography reveals a secundum atrial septal defect (ASD) with Qp:Qs ratio of 2.5:1. Regarding the natural history, hemodynamics, and management of secundum ASD, all of the following are true EXCEPT:

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