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It can be genetic or from trauma/injury...my brother had a hole in his heart and was basically missing one wall of his heart...one of the kids over at the hobby shop i go to has had a surgery for every year he has been alive till he was old enough that he stopped growing...i think his hole involved his what do they call it ah one of his valves so he had to have it replaced...this is all i know...if your really interested talk to/get in contact with the cleveland clinic
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