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Figure 1
ECG: sinus rhythm, normal QRS axis, minor right bundle branch block and inverted T waves in DI, aVL, V2–V6.
Figure 2
Transthoracic echocardiography modified parasternal short axis view. (A) 2D and color Doppler examination: large colour-flow pulmonary regurgitation jet width suggestive for severe pulmonary regurgitation. (B) CW Doppler examination: dense, steep deceleration of pulmonary regurgitation jet CW signal, with a pressure half time of 98 ms, suggestive for severe pulmonary regurgitation; peak antegrade velocity 2.6 m/s, peak antegrade gradient 26 mmHg, suggestive for large residual pulmonary stenosis.
Transthoracic echocardiography, apical 2-chamber view, 2D examination: left ventricular apical hypertrophy in diastole (A) with systolic obstruction at this level (B).
Figure 5
(A) Transthoracic echocardiography, short-axis view of the apex, 2D examination: left ventricular apical hypertrophy. (B) Transthoracic 2D speckle-tracking echocardiography: paradoxical strain of the left ventricular apex suggestive of hypertrophic cardiomyopathy.
Figure 6
Cine end-diastolic images: Left: short axis at the level of the papillary muscles. Right: four chamber view. Apical left ventricular hypertrophy with a normal sized right ventricle can be observed.
Figure 7
Late gadolinium enhancement images show isolated left ventricular apical fibrosis (arrow). From left to right: three chamber view, four chamber view and two chamber view.
Figure 8
T1 mapping before contrast injection in short axis. Left: level of the papillary muscles. Right: apical level. The stars show the area for which the T1 time is measured: mid septal (non hypertrophied myocardium) 1004 ms with a calculated extracellular volume fraction of 26%, versus apical (hypertrophied myocardium) 1042 ms with a calculated extracellular fraction of 30% - suggestive of interstitial fibrosis in the hypertrophied apical segments.