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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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