Fig. (2).

OHCM patient with vortical SAM: Top panels are pre-SAM frames; bottom panels are post-SAM frames. In left panel red arrow points to coapted MV, orange arrow points to the closed aortic valve. In top middle panel white arrowhead points to Doppler color flow that forms the isovolumic vortex. In top right panel, the thin white arrow points to the vector flow maps of the isovolumic vortex. Note that a limb of the clockwise anteriorly directed vortex flow impacts the posterior surface of the mitral leaflet tip with high angle of attack (thin white arrow). The bottom panel show that the aortic leaflets are still closed. There is now a confluence of vortical flow and early ejection flow that impacts the MV with high angle of attack (lower right enlargement). Reproduced by permission from Ro R et al. J Am Coll Cardiol 2014 same as Fig. (1).