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A 37 year old hypertensive woman was hospitalised for evaluation of a heart murmur. Echocardiography showed left ventricular hypertrophy with ventricular septum thickness (VST) of 15 mm and left ventricular posterior wall thickness (LVPWT) of 12 mm. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were 229 g/m2 and 0.68, respectively. Magnetic resonance imaging also revealed mild left ventricular hypertrophy (left). Coronary angiography showed anomalous origin of the left coronary artery from the pulmonary artery and severe dilatation of both right and left coronary arteries. Pulmonary–systemic flow ratio was 2.0. Surgical correction was performed by direct reimplantation. One week after surgery, the patient had exertional dyspnoea. Echocardiography and magnetic resonance imaging (right) showed increased left ventricular thickness (VST, 20 mm; LVPWT, 19 mm). RWT was profoundly increased to 1.30 and LVMI was unchanged (226 g/m2). Six months later, left ventricular wall thickness regressed to the preoperative size (VST, 16 mm; LVPWT, 12 mm), and symptoms had disappeared.
The left ventricular mass was unaltered, although the left ventricular cavity size was substantially reduced and severe left ventricular wall thickening appeared transiently after closure of the left to right shunt, presumably owing to the rapid reduction of left ventricular volume. The increase in left ventricular wall thickness caused uncompensated diastolic dysfunction and exertional dyspnoea.
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