VSD, RVH no PH but LA Enlarged. WHY?

hello,

I happened to come across this patient during an echo, an 8 yr old girl with a 16mm VSD, RV Hypertrophy, no Pulmonary Hypertension (PH) but the LA was enlarged. Can anyone explain to me, the reason for LA enlargement?

[Marie M Gleason, M.D.]

If an 8 year old girl has a 16 mm VSD (large), it would seem almost impossible to be free of pulmonary hypertension, unless the pulmonary bed is protected by pulmonary stenosis. The right ventricle is reportedly hypertrophied, so its pressure has to be higher than normal.  What direction is the shunting at the level of the VSD?  If left to right, then the left atrium is dilated due to increased pulmonary blood flow.

[Raj92]

Thank you for your help. I checked for PH and was very surprised myself. The shunt is L to R. I shall check for Pulm Stenosis again. If they come out negative I shall search for associated conditions like  PDA or maybe a ruptured sinus of Valsalva into LA due to coarctation of aorta.
Thank you very much for your advice.