Fig. 7 Echocardiographic and continuous-wave Doppler images at the obstructive apical ring show a short interval of early systolic blood flow (A), which was interrupted for most of systole and followed by a higher blood-flow velocity peak in early diastole (B), at the time of the delayed diastolic relaxation. See also Figure 3. Therefore, the intraventricular systolic gradient did not seem to be caused by blood flow, but rather by systolic contraction of the obstructive ring in the presence of systolic obliteration of the apical cavity.