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A 26-year-old man with severe right ventricular hypertrophy
  1. Jordan D Awerbach1,
  2. Cary Ward1,
  3. Michael J Campbell2
  1. 1 Division of Cardiovascular Medicine, Duke University, Durham, North Carolina, USA
  2. 2 Division of Pediatric Cardiology, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Jordan D Awerbach, Division of Cardiovascular Medicine, Duke University Medical Center, Durham NC 27710, USA; jordan.awerbach{at}duke.edu

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A 26-year-old man with a history of a perimembranous ventricular septal defect (VSD) was admitted to the orthopaedic service after sustaining a tibial fracture in a motor vehicle accident. He was lost to cardiology follow-up after age 10, at which time his echocardiogram demonstrated a restrictive VSD (gradient of 80 mm Hg across) and mild flow acceleration without obstruction through the right ventricular outflow tract (RVOT). Cardiac examination on admission was notable for a palpable RV lift and a harsh 3/6 systolic ejection murmur audible throughout the precordium. An echocardiogram was obtained, demonstrating new …

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