Abstract
Fig. 1. (A) Continuous-wave Doppler flow velocity waveforms (white arrowheads) propagated from the apex to the base of the left ventricle during systole, followed by high-speed blood flow in early diastole; i.e., diastolic paradoxical jet flow (yellow arrows). The blood flow from the base to the apex of the left ventricle displayed triphasic waveforms, involving E-waves (E), A-waves (A), and high-speed waveforms (H), in the diastolic, presystolic, and early systolic phases, respectively. (B) A color Doppler image of an apical four-chamber view during diastole: diastolic paradoxical jet flow from the apex to the base of the left ventricle (shown in blue). (C andD) Isoproterenol stress echocardiography. The patient's diastolic paradoxical jet flow velocity (yellow arrows in C) was 544 cm/s, and the pressure gradient was elevated to 119 mm Hg, as estimated by flow velocity. Chest pain developed. Immediately after VVI pacing was started, the patient's diastolic paradoxical jet flow velocity (yellow arrows in D) decreased to less than 200 cm/s. (E) After pacemaker implantation (DDD with an AV delay of 80 ms), a small diastolic paradoxical jet flow velocity of 159 cm/s (yellow arrows) and a pressure gradient of 10.1 mm Hg, as estimated by Doppler flow velocity imaging, were obtained.
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