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Left ventricular afterload reduction is essential to decrease the trans-se ptal pressure gradient and thus decrease shunt volume, making a larger proportion of the blood flow from the left ventricle through the aorticvalve.
Larger shunt volume means less blood exiting the left ventricle through the aorticvalve and lower cardiac output. The pressure gradient in this case was significant indicating that the defect is rather small. The larger the size of the defect the larger the shunt.
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