A 14-year-old girl with Down syndrome and repaired complete atrioventricular (AV) septal defect followed by resection of subaortic stenosis was brought to cardiac catheterization for evaluation of recurrent subaortic stenosis. Her baseline electrocardiogram (Fig. 1) showed left-axis deviation with nonspecific intraventricular conduction delay (QRS duration, 134 ms). She had significant left ventricular outflow tract (LVOT) obstruction, with a peak gradient of 52 mmHg.
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