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A 12-year-old southeast Asian boy with a past history of a small ventricular septal defect presents in heart failure. He is afebrile. He is thin, has a bulging praecordium and a prominent apical impulse. He is not cyanosed or clubbed. He has a pansystolic murmur and a high-pitched early diastolic murmur at the left sternal edge. His chest x-ray shows cardiomegaly without plethora. His blood count and inflammatory markers are normal. What complication of his original lesion best explains his heart failure?
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