Fig. 3.

Three months later, a parasternal long-axis view during diastole (a) and systole (b) showed the disappearance of pericardial effusion. However, pericardium was thickened to 8 mm (a, b, arrows). An M-mode echocardiography at the left ventricle showed septal bounce, which means movement of the interventricular septum to the left ventricle during inspiration (c). A pulsed-wave Doppler echocardiography at the mitral inflow showed inspiratory decrease in E wave velocity (d). Medial (e) and lateral (f) mitral annular tissue Doppler recording showed increased early relaxation velocity (e′) with medial velocity greater than lateral (annulus reversus). A pulsed-wave Doppler recording within the hepatic vein showed prominent diastolic flow reversal in expiration (g). These findings were diagnostic of constrictive pericarditis.