Intrinsic dynamic iatrogenic obstruction of the right ventricular outflow tract (RVOT). Mid-esophageal inflow/outflow views during (A, B) diastole and (C, D) systole. Notice the significant decrease in the size of the RVOT tract during systole. (E) Systolic pressure gradient of 22 mm Hg between the pulmonary artery pressure (Ppa) and the right ventricular pressure (Prv) across the RVOT. (F) Intraoperative aspect of the RVOT obstruction (dotted line). (See Videos 2 and 3, view videos online.) LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. Reproduced with permission of Taylor and Francis Group, LLC, a division of Informa plc. from Denault et al.251 © 2018 Taylor and Francis Group.