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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 …
Contributors JDA drafted the initial manuscript, and selected and edited included images. CW and MJC contributed to revisions and image selection. All authors have reviewed and approved of the manuscript in its final form.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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